Feds Delay Costly New Coding System
Medical Economics Feature – April 2012
By Ken Ortolon
The Texas Medical Association won a huge victory in February when the U.S. Department of Health and Human Services (HHS) pushed back the October 2013 implementation deadline for the International Classification of Diseases and Related Health Problems, 10th Revision, also known as ICD-10.
The action came after the American Medical Association, acting on a resolution the Texas delegation took to the AMA House of Delegates in November, urged HHS to stop ICD-10 implementation and to seek alternatives to replace the existing ICD-9 diagnosis and procedure codes.
Beaumont orthopedic surgeon and Texas delegation member David Teuscher, MD, says implementation of ICD-10 would have been "very difficult and very expensive" for physicians without providing any benefit for doctors or their patients. He also says the HHS decision shows the power organized medicine can wield.
"This is an example of what happens when physicians get engaged in organized medicine and try to make a difference," said Dr. Teuscher, who spoke in favor of the Texas resolution at the AMA meeting in November. "This is what works about TMA and the Texas Delegation to the AMA."
But experts say the HHS decision is only a temporary reprieve from ICD-10. And Dennis Flint, director of consulting and education services for Complete Medical Solutions, urges physicians to "stay the course" and continue their preparation for "the inevitability that ICD-10 is coming" eventually. Complete Medical Solutions is a Louisiana-based software company specializing in practice management software, hardware, consulting, and education services.
"We're not sure how long the extension is going to be," he said. "We're thrilled with the extension. We applaud TMA's efforts to spearhead the campaign to delay. But we don't know what we don't know."
Hold Your Horses
On Feb. 16, Health and Human Services Secretary Kathleen Sebelius announced that her agency was postponing the scheduled Oct. 1, 2013, ICD-10 implementation date for physicians and other health care entities. She did not say how long the delay would be, but said HHS would announce a new compliance date "moving forward."
The action came after AMA Executive Vice President and Chief Executive Officer James Madara, MD, wrote House Speaker John Boehner (R-Ohio) asking Congress to stop ICD-10 implementation.
The ICD-10 mandate "will create significant burdens on the practice of medicine with no direct benefit to individual patient care, and will compete with other costly transitions associated with the quality and health IT [information technology] reporting program," Dr. Madara wrote. He added that the timing of the transition "could not be worse as many physicians are currently spending significant time and resources implementing electronic health records in their practices."
Those were the same arguments that members of the Texas delegation put forward in urging passage of the ICD-10 resolution in November. The AMA House of Delegates unanimously approved a revised version of that resolution that directed AMA to "vigorously work to stop the implementation of ICD-10 and to reduce its unnecessary and significant burdens on the practice of medicine."
The final resolution also directed AMA to work with other national and state medical and informatics associations to assess an appropriate ICD-9 replacement.
Joseph Schneider, MD, of Dallas, chair of TMA's Ad Hoc Committee on Health Information Technology, brought the original resolution to the TMA delegation. He says ICD-10 was a huge burden to place on physicians when they face numerous other administrative hurdles, including implementing and achieving meaningful use of electronic medical records (EMRs), meeting quality measures under Medicare's Physician Quality Reporting System and other programs, the impending creation of accountable care organizations in Medicare, and more.
"The multitude of government programs all crashing together at the same time is a recipe for disaster in terms of our ability to do these well," said Dr. Schneider, vice president and chief medical information officer and medical director of clinical informatics for the Baylor Health Care System.
Dr. Schneider says ICD-10 also is old technology not designed to work in the current electronic world. Other countries have used the coding system for more than 20 years.
"ICD-10 was developed during the 1980s and implemented during the 1990s," he said. "It's a coding system of the last millennium. EMRs were crude at that time, and the Internet was just a twinkle in Al Gore's eye."
The fact that a new version of the diagnostic and procedure codes, ICD-11, could come as early as 2015 convinced Dr. Schneider that the United States should not implement ICD-10. While ICD-11 is still in its formative stages, Dr. Schneider says it is being designed for use with EMRs and the Internet and, therefore, should be more user friendly than ICD-10.
"Why in the world would we want to spend the money putting in 20-plus-year-old technology when the newer version is coming along in two or three years?" he asked.
Not only is ICD-10 likely to be outdated soon, it also does nothing to improve care for patients, says Dr. Teuscher. "It wasn't going to end up in any better health care. It wasn't going to end up with better safety," he said.
Dr. Teuscher called ICD-10 a "boondoggle" that would help only health care researchers and Medicare recovery audit contractors (RACs) seeking to recoup overpayments from physicians.
Experts such as Mr. Flint say the increased specificity of illnesses and conditions that the thousands of new codes will afford will indeed produce better quality data for health care researchers and those trying to better manage diseases.
"If the purpose is to make it easier for researchers to do research, I don't think we can afford that," countered Dr. Teuscher, who pointed out that ICD-10 is expected to cost solo physicians as much as $83,000 and group practices of up to 10 doctors as much as $250,000. "If the purpose was to make it easier for RAC auditors to come and say we over-billed or over-charged and we owe them a bunch of money, I don't think we can afford that, either."
TMA believes HHS should skip ICD-10 altogether and look for a better alternative, possibly ICD-11. Dr. Teuscher says he will "work like heck" to make sure ICD-10 is never adopted.
But Mr. Flint says that's not likely to happen. And Dr. Schneider is concerned. "I strongly suspect that CMS [U.S. Centers for Medicare & Medicaid Services] is going to still try to pursue ICD-10."
Mr. Flint is glad HHS announced the ICD-10 delay because so many physicians his firm consults with were woefully behind in implementation of the new code set. He says physicians should not view the postponement of the 2013 deadline as an invitation to cease their implementation efforts.
"To sit back and do nothing would be a poor choice," he said. "It would behoove the docs to get caught up now and not sit back and wait."
TMA Practice Management Services will offer educational programs and an ICD-10 conversion tool once HHS sets the new implementation date.
"This delay shouldn't be seen as an invitation to stop preparing for ICD-10. If physicians bet on HHS bypassing ICD-10 altogether, and that doesn't happen, it could be disastrous," said Carl Trusler, MD, of Abilene, chair of TMA's Council on Practice Management Services. "If anything, this has provided more of an opportunity for physicians to take advantage of the ICD-10 resources that TMA has available, so that the transition is more manageable when it does occur."
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
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