Skip to main content

ICD-10 Proponents Cry Foul

 |  By cclark@healthleadersmedia.com  
   March 01, 2012

Health and Human Services Secretary Kathleen Sebelius has made it official that her agency will "initiate a process" to "examine the pace" of ICD-10's implementation, with a new compliance date forthcoming. But many quality leaders and providers, not to mention vendors, who attended at HIMSS12 last week are imploring HHS to hang tough.

The pro-ICD-10 crowd insists ICD-10 should not be delayed. But if it must be, they want any postponement to be short-lived, limited in scope or perhaps phased in with a transition period. And they are mustering a fight to make their case.

"Our stance is, we're opposed to any kind of delay," says Sue Bowman, director of Coding Policy and Compliance for the 64,000-member American Health Information Management Association (AHIMA).

"It's just so ironic to me," Bowman continues. "We're all talking about how much we need to cut healthcare costs and improve quality of care. And how we're not where we want to be with quality. And oh, by the way, we're not going to bother upgrading our healthcare data. It just doesn't make any sense."

What HHS Secretary Kathleen Sebelius fails to fully appreciate, Bowman says, is that "an enormous amount of money has been poured into this process already by the healthcare industry—many, many millions." But they will have to spend a lot more if this is delayed.

"I've heard of some organizations talking about numbers like, $50 million, $60 million and even $90 million that they've already spent. Look at the timeline: We're closer to what was going to be the finish line than we are to the starting gate."

Bowman refers to comments by Lyman Sornberger, executive director of revenue cycle management for the Cleveland Clinic Health System in the ICD-10 Monitor, saying his organization will spend $26 million for full adoption of ICD-10 transition. If there's a delay, Cleveland Clinic will end up spending $37 million, or $11 million more.

Bowman says organization leaders tell her more money will be spent because they'll have to do things twice, cancel or extend contracts, and relaunch new training programs for whatever new start date is determined. If they train too soon, coders may forget what they learned. They also may have to maintain two systems simultaneously, perhaps revisit the vendor selection process.

To get better data, AHIMA is now sending a survey to its members "to learn how much their organizations have already spent on ICD-10 and how much different lengths of delay would cost them additionally," Bowman says.  "There are people who in good faith started working diligently when the rule first came out, and are now being smacked down, essentially," she says.

John Casillas, HIMSS senior vice president, tells me his group is "holding fast to the notion that October, 2013 is going to be the drop dead date, with the understanding, though, that this might be a good time to discuss a transition period." Casillas says he interprets Sebelius' statement to mean HHS might delay for some providers that can demonstrate implementation hardship, but not others, though the mechanics of how that would work are confounding.

Bowman adds that other than the American Medical Association's top leadership, which vociferously and successfully opposed the October 2013 switch date, she doesn't know where other opposition is coming from.

Despite those physician views, many members of the AMA—as well as the many physicians who are not members—privately tell her they don't want the switch date postponed, she says. The AMA represents a relatively small number of physicians in the U.S.

In a statement last week applauding a delay, AMA President Peter Carmel, MD, said "the timing of the ICD-10 transition could not be worse for physicians as they are spending significant financial and administrative resources implementing electronic health records in their practices, and trying to comply with multiple quality and health information technology programs that include penalties for noncompliance."

But Bowman says the AMA exaggerates the amount ICD-10 will cost smaller practices. "I think there's a lot of misinformation that has really scared some people. I don't think that for a provider it's going to bankrupt them or cost millions of dollars to transition," she says.

"I've had a couple of physicians tell me that they feel like the whole physician community is getting a bad rap. It's not like every physician in the United States is vehemently opposed to ICD-10. They are just reluctant to speak out right now. A lot of the medical specialty societies have been deeply involved for a long time in the development of ICD-10...(and) in fact, they helped write a lot of the codes."

But some physician opposition has been building. According to a survey by HealthLeaders Media last April, respondents said the number one challenge providers named in preventing them from attaining ICD-10 readiness was physician cooperation.

A week ago, AHIMA's President Patty Thierry Sheridan and its Chief Executive Officer sent a strongly worded letter to HHS Secretary Kathleen Sebelius criticizing the decision to delay. Among the points raised:

  • The rule has been final since Jan. 16, 2009, after a 10-year effort by HHS and education campaigns to "let the public and the healthcare industry know that the United States was rapidly losing its ability to collect and use health information," for important initiatives on the horizon including "quality measurement, improved public health reporting, bio-surveillance, value-based purchasing and consumer health information."
  • A switch date has already been postponed for two years from Oct. 1, 2011 to Oct. 1, 2013.
  • A "large majority of the healthcare industry" has created new jobs, upgraded systems," and implemented electronic health record systems in preparation.
  • "Those who want to stop ICD-10 implementation do not understand the classification systems, how they are used, and their role in U.S. healthcare beyond the current reimbursement system and how they can be used to improve practice, including in the offices of individual practitioners."

Bowman and her organization note some other troubling aspects of such a delay.  Right now, there is a "code freeze" to allow a smooth transition, so no new codes are being added, she says. If there is a delay, will the freeze be lifted?

"Our members are concerned that the continued misuse of the ICD-9CM structure to accomodate codes will result in an inability to use data and also will continue the error rate caused by lack of specific codes."

And Bowman asks, how should academic code training programs respond, since they are already planning their expanded curricula for ICD-10's 2013 launch.

On February 17, just before the HIMSS12 conference in Las Vegas, and just after Sebelius announced the change in course, HIMSS leaders said it polled most larger providers and learned they "are taking the necessary steps to be ready for ICD-10" by October 2013, and that nearly 90% of 302 healthcare IT executives who responded to a HIMSS survey expect to meet the deadline.

It's not surprising vendors would be especially upset by a delay. One of them, Edifecs, which provides healthcare software, conducted a survey at the 2012 ICD-10 Summit in Florida revealing that the cost of delaying implementation just one year could cost the industry between $475 million to more than $4 billion.

It's unclear what HHS plans to do, and its vague notice seemed to hedge. The agency defended ICD-10's ability to "provide more robust and specific data that will help improve patient care and enable the exchange of our healthcare data with that of the rest of the world that has long been using ICD-10" and acknowledged that providers bound by the 1996 Health Insurance Portability and Accountability Act "will be required to use the ICD-10 diagnostic and procedure codes." 

That doesn't mean HHS is putting off implementation indefinitely, only that it will "reexamine the pace" of implementation. And that could mean not postponing it for everyone or, as Casillas suggests, finding some way for a phased transition.

I'm thinking this may present the possibility for additional financial and or technical support for smaller physician practices and others within the AMA who cried the loudest.

We're hearing chatter that HHS is expected to clarify this confusion in the next few days, and I know everyone is anxiously waiting for that.

Pages

Tagged Under:


Get the latest on healthcare leadership in your inbox.