Just eight months out from the ICD-10 compliance date, fewer than 10 percent of physician practices say they've made significant progress in their readiness for implementation, according to the Medical Group Management Association.  

As such, MGMA is urging the Centers for Medicare & Medicaid Services to "immediately take action" to help get practices on track.

"The critical coordination that must take place between practices and their software vendor, clearinghouse and health plan partners is simply not happening at the pace required for a seamless implementation," said MGMA President and CEO Susan L. Turney, MD in a press statement.

"Very simply, ICD-10 is behind schedule," she said. "MGMA continues to advocate on behalf of members and provide tools and resources to help practice executives make the transition to ICD-10 more cost effective and less disruptive to their organizations."

MGMA's requests of CMS include:

• Initiating complete end-to-end testing with physician practices – assessing claims throughout the entire business cycle
• Releasing all Medicare and Medicaid payment edits and advising commercial health plans to do the same
• Publishing on an ongoing basis the readiness level of all Medicare contractors and state Medicaid agencies
• Assessing the readiness and targeting outreach to practice management and electronic health record software vendors serving physician practices
• Continuing to expand provider education efforts, especially to smaller and more vulnerable organizations

"As the agency overseeing the nation's largest health plan, it is imperative that CMS show leadership by reversing its position and begin end-to-end provider testing," said Turney in a statement.

"The publication of testing schedules, payment policies and readiness levels are all necessary actions for both CMS and practice trading partners in the private sector," she added. "Without this preparation, there will be significant increases in cash flow disruptions to practices that will affect the ability to treat patients."

MGMA's research showed that information technology remained a huge obstacle for many practices, according to a news release.


Based on responses from more than 570 medical groups employing some 21,000 physicians, MGMA found that more than 80 percent of practices say that their PM software would require replacement or upgrading in order to accommodate ICD-10 diagnosis codes – up from 73.2 percent in June. Moreover, 81.8 percent indicate that their EHR needs to be replaced or upgraded, a jump from 65.3 percent in June.

The cost of doing so is considerable, of course. Just 41 percent of respondents reported that their cost to upgrade or replace their PM system software will be covered by their vendor, with about 50 percent of respondents indicating that their vendor will cover the cost of their EHR replacement or upgrade, MGMA found. For those required to cover these software costs, they report an average cost of $11,500 per FTE physician for the PM upgrade or replacement and $12,885 for the EHR. This translates into a cost of $243,850 for a ten physician practice for the ICD-10 software alone.

Meanwhile, MGMA also found that internal software testing was lagging. Just 8.2 percent stated that they have begun or completed testing with their EHR vendor, compared to 4.7 percent in June. Slightly more than 10 percent of respondents reported that internal software testing had begun or is complete with their PM vendor, a slight increase from 5.9 percent in June.

External communication and testing were also a challenge, according to the research. In June, 70 percent of respondents stated they had not heard from their major health plans regarding the date on which ICD-10 testing would begin. Six months later, nearly 60 percent said they still hadn't heard from their plans. Moreover, only 5.4 percent reported that they have begun testing with their major health plans. Almost 60 percent stated in June that they had not heard from their clearinghouse regarding a testing date, and nearly 50 percent indicate they still have not heard. Only 8.1 percent reported that they had started testing with their clearinghouse.

And, as always, says MGMA, physicians' concern about clinical documentation and loss of productivity was acute. The number of respondents who said they're concerned or very concerned about the expected changes to clinical documentation remained constant at about 89 percent. Similarly, about 89 percent reported in both January and June that they were concerned or very concerned about the loss of clinician productivity after implementation, and 86 percent about the loss of coding staff productivity.

Finally, the expected change in difficulty for clinicians to select appropriate diagnosis codes remains extremely high, MGMA found, with nearly 98 percent expecting it will be somewhat or much more difficult under ICD-10.

[See also: ICD-10 'storm' posing dilemmas for health information management strategies]