Intelligence Unit Special Reports Special Events Subscribe Sponsored Departments Follow Us

Twitter Facebook LinkedIn RSS

ICD-10 Cost, Timing Concerns Explain AMA Vote



"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," says AMA President Peter W. Carmel, MD, about the mandatory switch to ICD-10.



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
DonS (11/17/2011 at 11:24 AM)

(this may be duplicate post - I apologize) Facebook: "Say NO to Icd-10" Ask CMS and the payers how they are doing in ICD-10 conversion? This is not just learning codes. It is changing systems (payer, provider, clearinghouse) and updating claims payment logic. Let hospital systems make the change first on their UB92 billing forms – the doctors can learn the codes. Leave the CMS 1500 filers out of it. As excited as everyone got about Y2K, I can't believe there isn't more concern about this change. If you shake an ICD-10 supporter hard enough, will a salesman fall out? Supporters have books and training to sell, consulting services to market and coders to recertify. The American healthcare system will not be fixed by ICD-10. We have other issues to focus on.
DonS (11/17/2011 at 11:21 AM)

My concern is whether CMS and Congress have been sold a "pig in a poke." Cheryl, would you be able to verify this information with your sources? 1. ICD-10 is NOT used in other countries in the PHYSICIAN office. (Germany does and supposedly is throwing it out or modifying it in some fashion due to issues) 2. Other countries used modified sets of codes. Canada only uses 17,000 codes and Australia only uses 22,000 codes and again, only in the hospitals. Rob Tennant, MGMA Government Affairs staff, indicated that when he contacted the Canadian government and told them that we were going to have to use 70,000 in the offices, they literally laughed. 3. Governments of other countries paid for new coding 4. Other countries pilot tested and implemented in stages over several years. 5. Auto insurers and Worker comp carriers are remaining on ICD-9 ICD-10 could be wonderful and perhaps needed in some ways. I am not arguing that point, except that I do not think it benefits a small physician practice in Bluffton, Indiana or rural New York State. They will receive NO benefit to this change, yet incur costs. These are private individual small businesses (although admittedly their number is shrinking) incurring this cost. A direct cost to buy systems, change systems, train personnel and the indirect cost of lower productivity. Can someone at AHIMA or wherever tell us the truth about ICD-10 rather than the generic guilt trip – The US is the last country to adopt? "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." Are there specific examples on 'patient outcomes' and how is this advantageous to a physician? Do we even use ICD-9 for this now? My multi-specialty group sure doesn't see this. "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." So what? What does 'support' mean? Procedures are paid on CPT codes – changing diagnosis does not affect payment. 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. The cynic will say that ICD-10 specificity will be used by payers to deny services even more. They will be able to say only certain procedures are supported by very specific codes. More detail to wade through to get a claim paid. Lastly, she argues, "It's important to remember that as time marches on, ICD-10 doesn't get any easier or cheaper to implement." Which is why many of us support eliminating ICD-10 conversion in physician practices, not a delay. We turned down the metric system. "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." Take advantage for what? Two final points: Ask CMS and the payers how they are doing in ICD-10 conversion? This is not just learning codes. It is changing systems (payer, provider, clearinghouse) and updating claims payment logic. Let hospital systems make the change first on their UB92 billing forms – the doctors can learn the codes. Leave the CMS 1500 filers out of it. As excited as everyone got about Y2K, I can't believe there isn't more concern about this change. If you shake an ICD-10 supporter hard enough, will a salesman fall out? Supporters have books and training to sell, consulting services to market and coders to recertify. The American healthcare system will not be fixed by ICD-10. We have other issues to focus on.
Aditya (11/17/2011 at 9:48 AM)

Interesting that the shift to the new ICD 10 coding scheme is facing opposition from the AMA.ICD 10 coding consists of around 155,000 codes an almost ten fold increase over ICD9 this increases specificity and granularity,thereby providing better diagnostics and targeted treatment of illnesses.Just read an informative whitepaper, ICD 9 to ICD 10 transition on benefits of ICD-10 and strategies for successful transition to the new coding format @http://bit.ly/rUq4Jz