Member Spotlight: AHIMA
Introducing Member Spotlight, a profile of each member of the Coalition for ICD-10. This continuing series will focus on each member’s contribution to ICD-10 advocacy efforts. First up: the American Health Information Management Association (AHIMA).
The American Health Information Management Association (AHIMA) has been involved with advocating for the adoption of, and contributing to the development and maintenance of, the ICD-10-CM/PCS (“ICD-10”) code sets since their initial development in the 1990s. We also were involved in the ongoing maintenance of ICD-9-CM over its lifespan, and have very much aware of the increasing inability to update this code set adequately or expand it to effectively meet rising demands for detailed healthcare data. Thus, AHIMA and its members fully recognize that replacing the obsolete ICD-9-CM code set is not optional. We have known for a long time that its limited structural design lacked the flexibility to keep pace with changes in medical practice and technology – a problem that has only worsened the longer ICD-9-CM continues to be in use.
In addition to the impact on US healthcare data, AHIMA is acutely aware of additional adverse consequences of the delay in moving to ICD-10, such as the impact on health information management (HIM) educational programs and students. Academic curricula were modified to incorporate ICD-10 education, resulting in both ICD-9-CM and ICD-10 education being provided for a period of time. It is difficult and expensive to provide comprehensive education in multiple code sets, and it is also challenging for individuals to learn multiple code sets at once. Based on the anticipated 2014 ICD-10 compliance date, schools phased out ICD-9-CM education and focused solely on ICD-10 education to ensure graduates entering the workforce at the time of the ICD-10 transition would be prepared with the right skill set. Delays in implementation cost schools money in training new educators and redesigning transition plans to account for the added time that dual coding education is needed. The previous ICD-10 delay, which re-set the compliance date from 2013 to 2014, caused schools to scramble to adjust their curricula to ensure students continued to receive ICD-9-CM as well as ICD-10 training.
While each delay has been costly and frustrating for the educational sector, the latest delay has been especially disruptive because of the proximity to the 2014 compliance date. In order to align students’ coding skills with the anticipated healthcare environment at the time of their graduation, an estimated 25,000+ students in HIM associate and baccalaureate educational programs were trained exclusively in ICD-10. Therefore, these students are ill-prepared for entering a workforce that still uses ICD-9-CM, jeopardizing their employment prospects. Delay in employment also makes it difficult to repay student loans. And in order to sit for the certification exam, new graduates will need to learn ICD-9-CM, as the delay led to an announcement by the Commission on Certification for Health Informatics and Information Management that all certification exams would continue testing on ICD-9-CM until ICD-10 is officially implemented. This further creates additional costs for schools that have chosen to offer this education to their graduating students. New HIM graduates will also need a refresher course in ICD-10 coding closer to the 2015 compliance date, unless they are fortunate enough to secure a job that affords them the opportunity to maintain their ICD-10 coding skills. The one bright spot for these students is that they are well-qualified to assist healthcare organizations with ICD-10 preparation, and so may be able to find employment or at least contract work related to ICD-10 transition projects.
Since AHIMA views the transition to ICD-10 as both inevitable and time-sensitive, the failure to replace ICD-9-CM more than five years after the final rule adopting the ICD-10 code sets is especially disappointing and frustrating for AHIMA and its members. Not only has each delay increased ICD-10 implementation costs, but also significant ongoing costs are being incurred because of the failure to replace ICD-9-CM. Continued use of the out-of-date and imprecise ICD-9-CM code set results in costs associated with:
- Erroneous decisions or conclusions based on faulty or imprecise data;
- Administrative inefficiencies due to reliance on manual processes;
- Coding errors related to code ambiguity and outdated terminology;
- Worsening imprecision in the ICD-9-CM code set due to the inability of the structure to adequately accommodate requested modifications, exacerbated by the partial code set freeze that has been in effect since 2011; and
- Lost opportunity costs from the failure to implement a more effective code set.
The triple aim of improving the US healthcare system – improving patient care, improving population health, reducing healthcare costs – cannot be achieved without better healthcare data. And better healthcare data will not be achieved until the transition to ICD-10 occurs. The quality of healthcare data continues to decline, leading to faulty decisions based on inaccurate or imprecise data.
The transition to ICD-10 is long overdue and simply cannot be put off any longer if the country hopes to make any real progress in improving patient care and controlling healthcare costs. Each delay is disruptive for healthcare delivery innovation, payment reform, public health, healthcare spending, and HIM education. Avoiding further delay in ICD-10 implementation is critical in order to limit implementation costs and to be able to begin to leverage the opportunities from the availability of better healthcare data.