As many of the front-of-the-pack payers steer from ICD-10 assessment into remediation, they are finding the transition to be more challenging and even more resource-intensive than they thought. And that realization is forcing payers to take a more pragmatic – and less strategic – approach to the conversion.
The general consensus has been that health plans gained the ICD-10 pole position and jumped out ahead of providers, but healthcare companies of all ilks have a lot on their plates right now.
“Organizations are very busy with health reform,” says Mark Williams, a partner in PricewaterhouseCoopers' healthcare unit. “They have to react pretty quickly to that.”
Healthcare reform, EHRs, and the HITECH Act, are among the initiatives distracting healthcare IT professionals from those HIPAA 5010 and ICD-10 conversions. Indeed, as they begin ICD-10 remediation, payers' conversion projects are slowing down, says Dave Biel, principal, Deloitte Consulting.
[Related: Turning to the cloud for HIPAA 5010 and ICD-10 compliance. Podcast: PwC's Mark Williams discusses leveraging ICD-10 to clean up your business.]
“Executives want to use ICD-10 as something innovative, but after assessments are complete, inevitably payers are moving more toward the pragmatic” Biel explains.
In other words: once payers find out the real expense, in time, people, resources, money, that ICD-10 will ultimately cost, they are reigning in expectations accordingly. Such payers have essentially down-shifted and are just looking to comply rather than reap business value or competitive advantage from ICD-10. What's more, without an uptick in activity, Deloitte's Biel says, health plans may be in danger of falling behind schedule.
This is not to suggest that ICD-10 initiatives are grinding to a halt. “I'd say the activity of clients getting into [preliminary] ICD-10 efforts continues to increase,” PwC's Williams adds. “It's still less than CMS might be hoping, especially on the provider side.”
Deloitte and PwC each have their own terminology for the varying approaches. On one side, Deloitte says there are payers that are innovators seeking strategic value, there are collaborators hoping at the most for a small return, and then the pragmatists are just complying with the federal mandate. PwC, for its part, breaks payers into quite similar categories of left, right, and center, with center being ICD-10 capable, meaning neither fully re-mediated nor entirely reliant on crosswalks, but meeting the mandate.
After assessment, “some clients are deciding they want to be more ICD-10 capable and not spending the most amount of money to be fully ICD-10 native because, frankly, they don't need to be right now,” Williams says.
[Podcast: The upside of a sibling rivalry between HIPAA 5010 and ICD-10 projects. See also: Top 5 HIPAA 5010, ICD-10 hurdles.]
Williams continues that the inverse is also true and some healthcare organizations that began with a minimalist approach in mind have up-shifted, moved into that PwC “center” spot, and are realizing that ICD-10 will bring business value and competitive advantage, if not come October 1, 2013, then at least sometime in the subsequent months.
That sort of thinking may be something of a silver-lining in payers' turbulent transition from assessment to remediation. “Health plans are are embracing the need to collaborate with each other as well as crossing party lines to work with providers,” Deloitte's Biel adds.
Even still, this remediation reality doesn't bode all that well for providers, with plates as full as their payer brethren, and particularly not for those still lagging behind in their ICD-10 assessments.
Tom Sullivan blogs regularly at ICD10Watch.com.
