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.
The AMA resolution itself predicts "a staggering increased work burden on physicians and their staff, with no direct benefit to patient care."
But Sue Bowman, director of coding policy and compliance for AHIMA, the American Health Information Management Association, said the delegates' vote was "surprising and disappointing" to her and her colleagues. And she disagrees with Carmel's statement that ICD-10 won't benefit patient care.
That's because, she says, physicians and the entire healthcare industry can learn a lot from the much more precise data ICD-10 can reveal.
"One of the advantages of ICD-10 is better information on patient outcomes," Bowman says. "And that can be advantageous to physicians - not necessarily detrimental. For example, it might show that a procedure is more complicated and might have higher risks or be associated with more complications. Today, a lot of these simpler as well as more complex procedures are lumped into the same code. It can help to support the physicians who are doing more complex procedures."
ICD-10's specificity, "can be used to support the medical necessity of a physician's service," which might be denied by a health plan under ICD-9 codes that are overly broad, and not explain why the service really was appropriate.
AHIMA, which has 63,000 members, include payers, hospital providers, vendors, government and health data agencies.
Bowman added that those concerned about moving from the antiquated coding system, "have had an extensive public debate about ICD-10 over the last 10-15 years, and the federal government has come out with a final regulation to move forward." The government was responsive to those concerns, even delaying implementation by several years.
Lastly, she argues, "It's important to remember that as time marches on, ICD-10 doesn't get any easier or cheaper to implement."
"With meaningful use, electronic health records, value-based purchasing and payment reform, frankly, a lot of us wish we already had ICD-10 in place. If we did, we could be taking advantage of better data today."
The AMA delegates, however, are steadfast. In their resolution they make the following points:
- Physicians are already under much stress both from increased paperwork and increased financial obligations of the Patient Protection and Affordable Care Act and electronic medical record requirements
- If ICD-10 is enforced to the letter of the law, physicians will need certified coders to read the physician's notes and add the diagnosis codes in order to prevent payers from denying payment."
The AMA released a fact sheet assembled by the American Academy of Orthopedic Surgeons, the Medical Group Management Association, the American Academy of Dermatology, the American College of Physicians, and several other groups, saying that the key cost impacts fall in six areas:
- Staff Education & Training costs associated with an ICD-10 mandate would range from $2,405 for a small practice to $46,280 for a large practice.
- Business-Process Analysis of Health Plan Contracts, Coverage Determinations & Documentation range from $6,900 for a small practice to $48,000 for a large practice.
- Changes to "Superbills," a new claim form software, would range from $2,985 for a small practice to $99,500 for a large practice.
- IT System Changes range from $7,500 for a small practice to $100,000 for a large practice.
- Increased Documentation Costs range from $44,000 for a small practice to $1.785 million for a large practice.
- Cash Flow Disruption range from $19,500 for a typical small practice to $650,000 for a typical large practice.