What We Learned – Two Points for ICD-11

What did we learn from the ICD-10 implementation and what can the healthcare industry apply to ICD-11? Answer: The implementation must be phased in.

With the World Health Organization ICD-11 adoption date planned for May 2018, we must plan now to achieve a smoother and less costly transition. The implementation process must be in phases.

It is difficult for all players to start at the same time at the same location and arrive at the finish line at the same time while dependencies exist. The delivery of healthcare is a process. Not only must treatment flow within the system but also reimbursement and, both require a software coding classification system.

In order for the provider and payer to acquire the software, implement and test, the vendor must have the software ready and complete with internal testing for sale. The process flow looks like this:

As was the case with ICD-10, some vendors did not have their software ready for purchase by the provider and payer leaving less time for them to test, both internally and externally. This also created risk for the payer as they did not know the state of the providers’ claims.

Solution is to phase in ICD-11 across the healthcare system.

The second requirement in the transition to ICD-11 is – the healthcare industry must invite the AMA, American Medical Association, to the ICD-11 table and the AMA must participate. While it may be true – 3M was chosen over the AMA to create the ICD-10 code sets, and the Obama Administration did not invite the AMA for input into the Affordable Care Act – the AMA must be an active participant in the transition to ICD-11.

Individual physicians, as well as, medical societies, associations and organizations were actively involved in the transition to ICD-10, but the AMA—as the governing body for physicians (a prestigious and respected entity in the US)—were not included in the creation of the ICD-10 code set or the implementation of the decision making.

To have greater success with ICD-11, the healthcare industry and the Government must invite the AMA to the table early in the process. And, the AMA must respond and participate.

World Health Organization Publications:

ICD-11 Newsletter Update November 2015.