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ICD-10 Cost, Timing Concerns Explain AMA Vote

Cheryl Clark, for HealthLeaders Media, November 17, 2011

The American Medical Association's House of Delegates' vote this week to "vigorously work to stop the implementation" of the "onerous" implementation of ICD-10, due in just 22.5 months, caught some healthcare leaders by surprise.

The resolution was brought by the AMA's Alabama and Mississippi delegations and the American Association of Clinical Urologists and the American Urological Association. It's unclear why those groups took the lead.

But the main concern shared by the members is cost, according to a statement from AMA President Peter W. Carmel, MD, issued during the group's interim meeting in New Orleans. The cost was estimated to be about $28,000 per physician. A 10-physician practice would spend about $285,195 to make the coding change, Carmel said.

Changing the coding system from ICD-9 to ICD-10, which was approved under a final federal rule in January, 2009 to take effect on Oct. 1, 2013, will raise the number of diagnostic codes from the 14,000 now in use to 69,000, and the number of procedure codes from 4,000 to 72,000, providing far more specificity for classifying types of medical care. The federal rule mandates the change because ICD-9 has been in effect since 1979, before many diagnostic diseases and conditions or medical procedures were even known much less classified.

But Carmel said the 2013 timing is terrible. "At a time when we are working to get the best value possible for our health care dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions," Carmel said in a statement this week.

"The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be–on their patients,” he added.

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6 comments on "ICD-10 Cost, Timing Concerns Explain AMA Vote"


RMartinez (2/12/2012 at 9:01 AM)
There are more facts to this than stated by those against the conversion. ICD-10 came out in 1993 and the US has been using ICD-10 mortality codes since around 1999. The current ICD-9 reflects our knowledge from the 1970's, when ICD-9 came out. Our ability as physicians to improve care is based on the quality of the data we have, so there is very good reason to install a more accurate system. Part of the push back and concern is that people are just now focusing on this and have concerns about cost. Understandable, but lets figure out how to improve the system and our practice for our patients. We are pretty good about getting things done when we put our shoulders together.

Diane Bristol (11/18/2011 at 11:35 AM)
Ms. Clark, I read your November 17, 2011, article on ICD-10 and it is clear that you're not in the trenches in a physician office. The estimated cost of implementation as well as lost productivity by the physician will lead to another access problem for patients. Learning an entirely new coding system and then finding the right code will be a costly, time-consuming project for both physicians and the billers/coders. I discussed ICD-10 implementation with my Congressman last spring. He indicated that Congress was led to believe that the USA was the last country in the world to adopt ICD-10. I provided him with MGMA information that no other country is using ICD-10 in the physician offices (with the exception of Germany) and other countries are only using a limited version of ICD-10 in their hospitals. For instance, MGMA provided information that Canada is using only 17,000 codes and Australia only 22,000 codes – and again, only in hospitals...not in physician practices. Canada and Australia took several years implementing ICD-10 one province/state at a time, and the governments of Canada and Australia paid for all expenses related to implementation. The cost of implementation of ICD-10 is estimated to be near $84,000 for my 3-physician office. Not only do we not have money available for this project, we have absolutely no way to recoup it if we borrowed it. Most patients are under some type of contracted payment – Medicare, Medicaid, BCBS, Managed Care plans, etc. Therefore, no matter what we charge for services, we only receive what the insurance company allows......the rest we write off. It amazes me that every other business in the country is allowed to increase their fees to recover increased costs except the field of medicine. ICD-10, in my opinion, is another unfunded mandate required by CMS with no real benefit to the patient. Diane Bristol MGMA member - Michigan

Steve Levine (11/17/2011 at 2:22 PM)
You left three key medical societies out of your list. We submitted a separate resolution that was also rolled into the one that passed. Please add the Texas, Nebraska, and North Carolina AMA delegations to your story. Thanks