This is a good article that brings about some points that “maybe” have not been mentioned yet. This is Dr. Halamka giving his run down on what they have been and are doing to prepare for the transition. First of all the money here and he estimates the cost will be around 8 million when done, and that is done with the work leading up to the 
change.
This is a good point here too, 146 systems that will need to be modified. ICD10 touches everything and everybody just about. He had to double the size of the coding staff and assumes a 50% reduction in productivity that will be forever and not change. He evens said they may have to use off shore coding which he pretty much leaves as a last resort if an ample amount of billers can’t be hired and kept on board as they leave it better opportunities come up.
Right now he stated none of the computer assisted was mature enough to add to their work flow. Many projects in the IT area has to be deferred as the focus has been on ICD10. So far there’s two and a half years invested. The original cost estimate of $600,000 for the hospital to convert is long gone, as he stated around $8 million instead. Also interesting to hear him mention the level of irritation with leadership in not understanding federal mandates too as they see this as being distractions (well don’t we all really) but as the good doctor says, 60% of the revenue cycle of the hospital is at risk so there’s the best reason right there to take it seriously…a big chunk of money.
In addition, and I’m sure other will chime in here too will be the auditing down the road. 
Shoot with what we see now can you imagine future audits with ICD 10 codes? They will be there and probably become part of the CMS nickel and dime analytics that also just go on forever. Below is a good example with the eRX program where the CMS data was not reliable and look what auditing they will be doing over their own mistakes. Of course we know the problem here is going back in time when that money has already been spent.
CMS Fiddling Around Now With eRX Program To Audit and See If Claims Submitted Failed, They Want To Get Some Money Back As “Their CMS” Programs Have Data Integrity Issues…
After you read this it’s almost laughable that CMS until recently was not even going to do any end to end testing! I don’t what’s wrong with those folks and said they should have additional testing after the first run as well. When things were in silos, testing was still needed but it was not as complex as we have out there today with everything connected. BD
WALTHAM, MASS.--It’s not the new code set of ICD-10, it’s getting meaningful data into the new codes that concerns John Halamka, MD, CIO of Beth Israel Deaconess Medical Center (BIDMC) in Boston, speaking at the Massachusetts Health Data Consortium’s March 10 conference on ICD-10 implementation.
BIDMC has been working on ICD-10 implementation for two-and-a-half years, including a complete redesign of workflows and retraining of every physician, nurse and member of business teams. The original ICD-10 regulations estimated an organization like BIDMC would need to spend $600,000 to successfully make the transition. Halamka said he has spent about $5 million and expects to reach about $8 million before the effort is complete.
Halamka also said he is concerned about being “audit-proof” when recovery audit contractors come. It will be “bounty hunters’ delight as they find the disconnect between what we actually documented and what we coded. That’s the technical dilemma.”
BIDMC has 146 different systems that have to be modified and fully tested for ICD-10, he said, to ensure that physicians will get the right code out to the billing agency.
Halamka said he has had no choice but to double his coding staff because “we have assumed that we will have a 50 percent reduction in productivity and that’s not short term—that’s a forever expense.”
As of initial testing results, “we were passing 835s successfully. So far so good. We can mechanically pass a code but whether the code is accurate, relevant or auditable--that’s a totally different problem.”
Rather than just working to meet the Oct. 1 implementation, Halamka said “ICD-10 is the gift that keeps on giving. ICD-10 has to still be on the docket as one of our major projects” for some time to come.
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