Survey: Most Large Healthcare Providers Ready for ICD-10 Testing

More healthcare executives recognize the long-term benefits of using ICD-10-CM/PCS than a year ago, according to a new eHealth Initiative (eHI)/AHIMA survey, and plan to use the code set for quality improvement and performance measurement once it is implemented. And while the majority of respondents working in larger healthcare organizations said they are far enough along in their implementation process to conduct end-to-end testing on ICD-10 before the October 1, 2015 deadline, smaller organizations said they are less equipped to test.

A report based on the survey was released Tuesday by AHIMA and eHI that provides a look at just how prepared healthcare organizations are for the upcoming ICD-10 implementation and how they think ICD-10 will impact their operations.

Areas of focus for the survey included readiness for testing and implementation, anticipated financial, clinical, and operational impact, and the strategic implications of an expanded code set. A total of 454 healthcare representatives, mainly from hospitals and physicians practices, participated in the survey conducted in May and June 2014.


Majority Preparing for End-to-End Testing

Sixty-five percent of respondents indicated that they could begin end-to-end testing prior to October 2015. Of these, 63 percent said they would be ready to conduct testing by the end of the year. Ten percent said they have no plans to test, while 17 percent didn’t know when their organization would be ready for testing. Of those not ready or willing to test, nearly half were clinics or physician practices, possibility indicating “a knowledge gap around ICD-10 implementation and testing for those organizations with fewer resources,” according to the report.

The results of the survey show that the majority of the healthcare community has continued to prepare for ICD-10 despite the most recent implementation delay, said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA.

“These results demonstrate that the healthcare community has stayed on track with preparation despite delays and that as healthcare executives continue to learn more about the specificity in ICD-10, they see clear value in it,” Thomas Gordon said. “AHIMA will continue to provide training and resources to help healthcare organizations, including small physician groups, prepare for implementation so all healthcare organizations and patients will experience the benefits of a modern and robust coding system.”


External Testing Plans Uncertain

Though the majority of organizations said they would soon start internally testing ICD-10, testing with external partners was less certain. Respondents frequently indicated that they were not aware of when their key business partners would be ready to conduct testing. Respondents were more likely to know when larger partners, such as clearinghouses, IT vendors, acute care hospitals, and health plans, were prepared to conduct testing.


ICD-10’s Positive and Negative Impact Weighed

The survey showed providers had a mix of concern and optimism about the impact of ICD-10. While 35 percent believed their organization’s revenue would decrease during the first year of ICD-10 use, only six percent thought their revenue would increase—and 14 percent felt ICD-10 would be revenue-neutral. Smaller organizations stated they were less ready to mitigate a possible decrease in staff productivity and/or revenue due to the ICD-10 implementation.

The majority of providers said they are concerned about the impact of ICD-10 on common clinical and administrative processes, with 59 percent saying coding patient encounters would be more difficult. Again, smaller practices indicated this would be more difficult than acute care hospitals. Sixty-one percent of clinics and physician practices believed that documenting patient encounters would be harder with ICD-10, compared to 35 percent of acute care hospitals.

When asked about their view of the long-term benefits of ICD-10, the majority of respondents said the new code set would make managing population health and conducting clinical, health services, or translational research easier. Organizations plan to leverage the increased specificity of the code set for claims processing and billing (63 percent), quality improvement (63 percent), performance measurement (52 percent), and outcome measurement (41 percent).

“Compared to data from a similar survey in 2013, the percentage of respondents planning to use ICD-10 for quality improvement, performance measurement, and outcomes measurement has increased, suggesting that organizations may better recognize the potential benefits of ICD-10 as they grow more familiar with the code set,” the report said.

Other results of the study include:

  • 70 percent of organizations plan to conduct additional training and practice prior to the compliance date to mitigate staffing challenges as they get familiar with using the new code set
  • 62 percent say they are using the delay to improve clinical documentation integrity
  • One-third of respondents plan to fill productivity gaps by contracting with outsourced coding companies
  • 32 percent plan to purchase computer-assisted coding technology or similar tools


Preparation Recommendations

As organizations work toward meeting the compliance deadline, AHIMA and eHI recommend that providers:

  • Test early and frequently. Testing should take place at all stages of implementation, not only in an end-to-end environment. Stakeholders should test systems as they work with their vendors to make upgrades and communicate with all of the individuals involved to ensure the system functions properly.
  • Collaborate. Stakeholders should reach out to peers and other organizations in their region to share best practices for ICD-10 implementation.
  • Mitigate risk prior to implementation. Strategies such as dual coding can help organizations mitigate the risk of ICD-10 implementation by familiarizing staff with the new code set in advance, thus improving coding accuracy and productivity.


The full survey results are available in AHIMA’s HIM Body of Knowledge at


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