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ICD-WHEN … But It Is Not Fair!
I have an 11-year-old daughter (I have a nine-year-old daughter too, but she is not part of this post, which ordinarily would be a problem except that HIStalk has a fairly low readership among the nine- to 11-year-old girl demographic, so I’m probably safe just referencing one kid.) My wife and I hear a very common phrase from our 11-year-old, which is, “But it is not fair!” (as you read the line, insert a foot stomp, a hand on the hip, or some exaggerated facial expression.) The good news is I’m told that challenging fairness or having an exaggerated sense of being wronged are normal things for a girl her age.
So why I am raising this?
A couple of weeks ago, our daughter told us the ultimate “But it is not fair!” story at the dinner table. She had a lot of homework and had stayed up late doing it, only to be told by her teacher the next day that since many kids complained, everyone would be given an extra day to complete the assigned work. She had strong feelings that, “But it is not fair!”
Let’s fast-forward to the shocking news we all heard on Thursday, March 27. The House had voted to delay ICD-10. Emails were flying around. Some were forwarded by well-intended people thinking they were breaking the news by passing on various listserv posts. Most were from leaders or team members deeply involved in the ICD-10 project. These emails — while sometimes containing more colorful language – essentially proclaimed, “But it is not fair!”
As I have thought about it, I guess that really is the right phrase to describe our ICD-10 delay situation. The root of the issue is that those organizations that have been preparing and working really hard at ICD-10 and sacrificing other things to get ICD-10 done feel wronged. We studied hard for the test, we made the sacrifices, we checked in with our bosses to be sure this was something we really had to do. Then, without warning, poof! Another delay.
Others feel ICD-10 has not been fair all along. This point of view would say that a break is needed from all the bureaucratic burdens, especially for small hospitals and solo physician offices.
So how do the pros and cons of this all play out?
On the cons side:
- Momentum. Many organizations had made room for the project and spent a lot of money to get ready. It will be hard to rally the troops again for the big ICD-10 project now that it has been delayed. ICD-10 with its many delays can officially be called ICD-WHEN? It will be hard to insist with credibility to physicians and others that we have to aim for a new hard date.
- ICD-9 was developed in 1979. That kind of stands on its own. That was 35 years ago. Things have changed, but the ICD codes have not.
- Monies have been invested and spent on training. Training, like computer hardware and milk, just don’t age well.
- We have transparency problems in healthcare today. Better coding was not going to solve that in itself, but it was going to help.
- Better analytics will come from better data. ICD-10 was going to help us get better data.
- It will be hard to quantify the opportunity cost of ICD-10. Since we all thought we had to do it, we skipped doing other things. More importantly, our vendors skipped doing other things. I bet folks have an impressive list of opportunities on their to-do lists.
- Many of our systems are now in limbo. Code is loaded and tested, but now those systems need to stand down.
On the pros side:
- Folks who need the extra time will have it.
- Heck, I guess ICD-11 is just around the corner.
- I suppose some version of phased go-lives might be possible with systems at larger hospitals on track.
- More dual coding data means more testing. It’s hard to say more testing is bad.
- With our extra time, we can find more obscure ICD-10 codes and make fun of them, like “V95.43, spacecraft collision injuring occupant.”
I’m disappointed that ICD-10 was delayed, probably equal parts for the delay itself and the way it was delayed. But in the end, I think this one is best summarized by my daughter: “But it is not fair!”