Monitors And Microphone Over Table In Radio Studio

The long-running weekly program focused on the current coding set debuted in May 2011.

When announcer Clark Anthony chimes in that “We’ve been waiting for you” online this Tuesday, the 500th episode of Talk Ten Tuesdays will be on the air.

And it’s a milestone that those long involved with the weekly Internet radio broadcast are using as an opportunity to look back and reflect.

“The journey to get to the 500th broadcast has, indeed, been memorial,” said Chuck Buck, executive producer and program host. “We have had the pleasure of having very important healthcare professionals as special guests, including those with the federal government.”

The landmark broadcast will feature 10 of those longtime contributors and national thought leaders, some of whom were kind enough to share their thoughts about the show – and the herculean process of introducing the new coding set to the American healthcare system – throughout the past week.

One of them had even been involved on the process from the inside, so to speak.

“I was writing healthcare regulations for Washington State when the Affordable Care Act (ACA) was passed, and moved to Baltimore in the fall of 2010 to work on ACA regulations with the Administrative Simplification Group. Initially, to my mind, ICD-10 was something that I didn’t have to pay attention to; there were all these requirements under the ACA that we had to focus on. But it soon engulfed our office and all the Medicare offices as well,” recalled Matthew Albright – today Chief Legislative Affairs Officer for Zelis. “My memory of that time was that Medicare, commercial payers, and providers were all under a tremendous amount of legislative pressure with ICD-10, 5010, Operating Rules, and Meaningful Use, all coming at the same time, and all of which our office was involved with. The ACA was really the first time CMS was broadly regulating commercial payers; before then, CMS was just another payer. Now, as an organization, it had to learn a lot more about the commercial market.”

Albright wasn’t alone when he felt consternation about the policy decision made to postpone ICD-10 installation – which came many years after most developed nations around the world had already implemented it.

“Much of 2012 was swallowed up with us writing a justification for why ICD-10 should be delayed,” he recalled. “The administration decided to delay ICD-10 for the simple reason that the industry was not ready for it, but you couldn’t justify delaying a regulatory compliance date just because people weren’t ready to comply. Lawmakers and regulators are always writing rules that are effective before people are ready for them.”

At times, it seemed unclear whether implementation would happen at all, Buck recalled. Initially, the American Medical Association (AMA) was a vocal opponent.

“I recall seeing former ABC news reporter John Stossel, then with Fox News, somewhat berate ICD-10 on the air. There was also a group of congressional representatives who lobbied against the anticipated arrival of ICD-10, including U.S. Congressman Louie Gohmert,” he said. “The opposition’s approach was very much like a negative political campaign that used fear tactics to warn of the dire consequences if the new code set were adopted.”

Stanley Nachimson, who followed a 30-year career with the U.S. Department of Health and Human Services (HHS) with high-profile consulting work – and the authorship of what’s today considered the authoritative paper on the cost of ICD-10 for physician practices – noted that the rollout wasn’t a walk in the park, either.

“The implementation did not go as smoothly as expected,” he said. “Many entities either miscalculated the time necessary to do the work, or simply postponed their work due to other priorities.”

Nachimson added that at first, the industry failed to recognize the need for cooperation among vendors, providers, and payers, not to mention the complex end-to-end testing necessary to ensure that entities had done their work accurately. 

Yet Talk Ten Tuesdays was pivotal in helping correct that.

“It has served as an independent, impartial, objective vehicle for reporting on industry issues, starting with the 5010 implementation and moving forward through ICD-10 implementation and even current coding issues,” Nachimson said. “It offers an opportunity for knowledgeable industry experts to explain issues and provide guidance, as well as pointing out other available resources. It also provides the opportunity for listeners to ask specific questions and get real-world answers. At its best, it shows the need for all facets of the industry to cooperate so that we can reach regulatory and other goals.”

“I think TTT and ICD10monitor were enormously helpful and essential tools for the ICD-10 implementation,” Albright agreed. “The industry needed a space where it could go, listen in, participate, where the conversation was not being managed by the government – remember, as the government, it was our job to be the cheerleader for the code set; it was not our role to facilitate constructive commentary.”

The broadcast ultimately grew far beyond the more parochial goal of focusing exclusively on the nuances of the coding set, as recalled by H. Steven Moffic, one of the nation’s premier psychiatrists.

“Way back in August of 2014, I got a call out of the blue to my hotel room in Albany, New York while on vacation. It was from Chuck Buck,” he recalled. “Somehow, he got my name as a potential resource, as he was having trouble finding a psychiatrist to discuss the death of the very popular comedian, Robin Williams.”

“Anyone who has experience with Chuck knows how hard it is to say ‘no,’ even on vacation, so I appeared on the next Talk Ten Tuesdays show to talk about his publicly known psychiatric diagnoses and how they may have related to his suicide,” Moffic added. “Most importantly, I wanted to relay how people should be skeptical about a loved one with mental illness suddenly appearing to be much better without good reason. It may mean they are relieved because they have decided to commit suicide, and go on to do so.”

The rest, Moffic said, is history.

“It was the beginning of a relationship that has continued ever since. For the first time since it began in 2011, the show began having a mental health feature,” he said. “I became the ‘resident psychiatrist’ and have probably averaged close to one appearance a month, along with occasional interview articles for ICD10monitor.”

Topics Moffic would ultimately cover expanded to include coder burnout, the social determinants of health (SDoH), climate change, racism, and the COVID-19 pandemic, among many others.

“With all the rapid changes in health and mental healthcare, to have such a long-running media show is so rare nowadays,” he said. “I always learn from other presenters and writers, not only in the broadcast, but in our half-hour of getting together before Talk-Ten-Tuesdays gets on the air. Chuck has a masterful, psychologically astute way to get everyone comfortable before the show begins. His legacy to date must include that he has done much to reduce the stigma of mental health, and reminding audiences that there can be ‘no health without mental health.’”

The broadcast’s legacy is sure to endure now that ICD-11 is on the horizon – a topic sure to dominate discussion for the next decade or so.

“We can learn from the lessons of ICD-10 in the need for cooperation among entities, and that there should be agreement as to the need for an upgrade,” Nachimson said. “There are also considerable other priorities for the industry, including interoperability, quality improvement, and security improvements which will have to be considered. An agreed-upon timeframe, which includes vendor development time, provider/plan implementation and training, and testing should be developed to guide the industry for a successful run.”

“We can’t just think of ICD-11 as a matter of course,” Albright added. “If we want ICD-11, we can’t just expect the government to drum up support for it or force the industry to do it. The proponents have to evangelize it before they even turn it over to the government. Evangelize it, and also run pilots, models, tests to show both its benefits and the possible pitfalls to implementation.”

Amid the uncertainty, one thing remains steadfast: that Talk-Ten-Tuesdays will continue to document the path, however winding it gets.

“Our programs were and continue to be a reflection of the times in which we work,” Buck said.

“TTT and ICD10monitor have left a great legacy, and should be credited with an ICD-10 implementation that was less than disastrous, if not successful,” Albright added. “Like Spidey (Spider-Man) says, ‘with great power comes great responsibility.’ We may need TTT and ICD10monitor to fulfill that role again soon.”

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