Impact of ICD-10 Implementation on Hospitals

The 10th revision of the International Classification of Diseases, or ICD-10,1 will change the way physicians and other medical professionals code clinical data. ICD-10 was slated to take effect on October 1, 2014, however, President Obama pushed the deadline to no sooner than October 1, 2015 to give hospitals more time to reorganize their staff and leverage their resources.2

This update will dramatically increase the 13,000 diagnostic codes in the now defunct ICD-9 system over fivefold to 68,000 codes. Changes include new methods of categorization, which will enable physicians to provide more specific diagnoses and treatments.

Impact on Hospital Operations

Making precise estimates of exactly how great the impact of ICD-10 implementation on productivity of coders is difficult. Fortunately, studies published during Canada’s transition to ICD-10 provide a good model and indicate that a decrease of 50 percent productivity could be anticipated.3

It took Canadian hospitals at least three to six months post-implementation before any appreciable gains in productivity were noticed and almost a year before productivity levels approached pre-ICD-10 levels.3 Moreover, productivity peaked at below pre-ICD-10 levels which may be due to codes being more detailed and requiring more rigorous searches through more voluminous information.

Many leading hospitals have determined that they will need at least six months of increased staffing levels before the ICD-10 transition.2 This requirement will impact systems as well, demanding six months of system readiness to support the coders, documenters, and other impacted personnel as they transition to ICD-10 for actual patient records. Staff training would require that onboarding takes place months before the actual transition date impacting productivity and taxing budgets.

Because good, experienced coders are already difficult to find, increased demand would inevitably lead to staffing shortages.

In preparation, hospitals can take some steps to ease transition:

  • Having coders split their work across ICD-9 and ICD-10 to retain a level of efficiency while learning the new standard.
  • Testing and upgrading systems as necessary to store and recognize ICD-10 documentation.
  • Monitoring coders’ performance and accuracy and providing tailored training to address weak points.
  • Finding ways to streamline operations to counter the productivity drop, such as installing RFID chips on IV drip poles, wheelchairs, and other crucial equipment to help staff locate them quickly.
  • Reworking hospital expenses to prepare for the cost of hiring, training, and compensation.

HealthcareIT News recently suggested that ICD-10 may improve patients’ satisfaction with their providers.4 A central problem with physician services is that patients often don’t know up front what their bill is likely to be and understand nature of treatment. ICD-10 codes provide much more detailed information about medical procedures and diagnoses to better describe severity and complexities of a patient’s condition. In theory, that would allay some of patients’ concerns.