Often, while talking to industry experts for a certain topic, I uncover an entirely new story. And lately, that emerging story is one of fatigue. For recent articles, I’ve reported on 5010, ICD-10 and meaningful use. Conversations that drill down into these topics increasingly begin with the phrase, “We have a lot on our plate.”
Simply put, providers are starting to reel under the weight of these multiple—and concurrent—federal mandates and programs. There are more than these three—there’s also the looming specter of health reform, with its accountable care organizations, adoption of more uniform HIPAA transactions and potential expansion of the insured Medicaid pool. There are looming payment audits under Medicare, whose RAC program is an after-the-fact effort to reclaim inappropriately paid claims, and commercial carriers likely will launch similar audits. As federal officials ramp up privacy and security enforcement, providers will have to enhance their protection of health information. To top it all off, there are some serious labor shortages among the key personnel needed to cope with these programs.
By itself, 5010 is a serious effort that will entail system upgrades and information food chain testing. Most organizations I talk to feel their systems will accommodate the new formats—which offer some streamlined workflows around benefits adjudication—but they’re not sure of their multiple trading partners. And indeed, those trading partners can number into the hundreds for larger organizations.
Compared to meaningful use and ICD-10, 5010 is largely a technical exercise. The new format will enable the transmission of the lengthier data fields in ICD-10, so it serves as something of the new electronic highway. But ICD-10, which symbolizes the traffic that will be moving on that pathway, is a project that reverberates throughout the entire delivery system. I’m interviewing several organizations for a forthcoming feature that have gotten a head start on ICD-10. And invariably, they are driving the project from the very top of the organization, with the executive sponsor being the CEO, COO, or CIO, and in some cases, all of the above.
Curiously, no one I talk to wants to see the ICD-10 deadline—already postponed once—delayed again. People seem to realize the importance of moving to an expanded code set to paint a better picture of services actually rendered and to measure outcomes. But I sense a type of weary resignation in the industry. After all, no federal program comes free of attached strings. And we're already seeing how tangled those strings are becoming with meaningful use.
Increasingly, some providers feel like marionettes being dangled on the federal strings. And they’re being directed to move their body parts in ways that are uncomfortable at best, painful at worst. Any injuries incurred are to be determined.
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