As healthcare organizations start the countdown to the October 2015 ICD-10 compliance deadline, a majority in a recent survey say they are far enough along in the implementation process to conduct end-to-end testing. However, smaller organizations—such as physician practices—appear less equipped to test. In addition, they are not aware of when their business partners will be prepared to conduct testing.

Those are among the findings of a survey of 454 individuals representing a wide range of healthcare settings including delivery systems, acute care hospitals, clinics and physician practices. The ICD-10 survey, conducted by the American Health Information Management Association and eHealth Initiative, assesses organizations’ readiness for testing and implementation, as well as anticipated financial, clinical and operational affects.

“As organizations implement the ICD-10 code set, testing is imperative to ensure that trading partners can ultimately accept the ICD-10 coded transactions,” states a new AHIMA/eHI report based on the survey results. “Testing for ICD-10 can be a complex task involving both internal and external resources, as organizations must validate their own workflows around coding and the ability of their trading partners to receive and process transactions. End-to-end testing is an important internal validation tool in which all components of a system are tested in an environment that closely mirrors real-world scenarios.”

According to survey results, 65 percent of respondents indicated that they could begin end-to-end testing prior to the fourth quarter of 2015, when compliance is set to begin. Of these, a majority (63 percent) will be ready to conduct testing in 2014, while the rest will wait until 2015. Ten percent of all respondents currently have no plans to conduct end-to-end testing, and 17 percent don’t know when their organization will be ready for testing.

Of the organizations with no plans to conduct end-to-end testing, the often cited reason was a lack of knowledge (36 percent). Nearly half (45 percent) of these organizations are clinics/physician practices, which AHIMA/eHI say might indicate a knowledge gap around ICD-10 implementation and testing for those organizations with fewer resources. By contrast, the report points out that only two of the acute care hospitals responding to the survey had no plans for end-to-end testing.

“While many organizations are poised to perform internal testing, the external testing picture is cloudier,” finds the report. “Respondents frequently indicated that they are not aware of when their key business partners will be prepared 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. More of these larger organizations have also indicated to their partners that they will be prepared for testing in 2014 than smaller organizations such as physician practices.”

When it comes to potential negative impacts, 35 percent of those surveyed believe that their organization’s revenue will decrease during the first year of ICD-10 compliance. Only six percent thought their revenue would increase and 14 percent viewed compliance as revenue-neutral. Nearly half the respondents are unsure about the impact or ICD-10 on revenue (18 percent) or have not yet conducted revenue impact assessments (27 percent).

In addition, respondents expressed concern about the impact of ICD-10 on common clinical and administrative processes. They indicated that coding (59 percent) and documenting patient encounters (42 percent), as well as adjudicating claims (41 percent) would be more difficult under ICD-10. At the same time, smaller practices may have a more difficult time adjusting than larger organizations.

“Across the board, a higher percentage of clinics and practices indicated that it would be more difficult to complete common clinical and administrative practices than acute care hospitals,” states the report. “Sixty-one percent of clinics and physician practices believed that documenting patient encounters would be harder, as compared to 35 percent of acute care hospitals. Likewise, for adjudicating reimbursement claims, 54 percent of practices thought ICD-10 would make the process more difficult, versus 40 percent of acute care hospitals.”

However, respondents also expressed support for the long-term benefits of ICD-10. More respondents believe ICD-10 will make managing population health and conducting clinical, health services, or translational research easier rather than harder. They also believe that ICD-10 will ultimately improve the accuracy of claims (41 percent), quality of care (29 percent), and patient safety (27 percent).

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