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Quick Note: ICD-10 Meets With Increasing Resistance, Spearheaded by AMA

January 31, 2012

Today’s Quick Note deals with the topic of ICD-10 codes, once again. A post titled “AMA to House Speaker Boehner: Stop ICD-10 ” appears in, and discusses growing unrest among physicians groups about the legislative mandate to support a scheduled 2013 adoptions of ICD-10 codes. ICD-10 codes are slated to replace ICD-9 codes as the health industry’s standardized diagnosis codex.

Today’s Note first covered the ICD-10 code transition in a September, 2011 post titled “Diagnosis Detail.” In the intervening months, resistance to the forced conversion has grown, and focused primarily on transition costs.

In the post, author Luke Gale focuses on the American Medical Association’s bid to derail the ICD-10 implementation in Congress. Gale starts by explaining that “American Medical Association CEO James L. Madara, MD, wrote to House Speaker John Boehner (R-Ohio) to urge him to take action against the implementation of ICD-10, informing him that the transition to ICD-10 as mandated by HIPAA would place a heavy burden on physicians without offering a direct benefit to individual patient care.” [all italics in this post are mine, and are used to emphasize quotes from the original post or article]

AMA CEO James Madara, MD, has complained to the Speaker that the Federal Government is doing a poor job of harmonizing its IT initiatives, and in the process places a heavy financial burden on doctors. Gale’s words:

Implementing ICD-10 will be costly to physicians and disruptive to their other health IT efforts, Madara declared, adding that federal health IT initiatives should be better synchronized.

Madara has something of a point. Doctors can hardly be blamed for feeling overwhelmed by the need to implement one IT project after another. In recent years, physicians have weathered HIPAA, HI-TECH, 5010, EHR and now ICD-10. Expensive, complicated and rarely smooth, physicians offices often struggle to divert attention and money from patient care to technology undertakings that few physicians probably understand well. Larger organizations, such as hospitals and insurers, may be more prepared to tackle IT projects, but the financial impact can be disproportionately large on such organizations. Gale discusses this issue at length and his take is good enough to warrant an unusually long passage excerpt:

“This is a massive administrative and financial undertaking for physicians, requiring education, software, coder training and testing with payors,” Madara wrote. “As HIPAA-covered entities, physicians are responsible for complying with this ICD-10 mandate, and therefore must bear the entire cost of such a transition, without any financial aid from the government. Depending on the size of the practice, the total cost of implementing ICD-10 ranges from $83,290 to more than $2.7 million.”

Madara added that the Oct. 1, 2013, deadline for ICD-10 implementation is asking too much of physicians who are currently implementing EHRs and e-prescribing systems to avoid financial penalties for failing to participate in meaningful use incentive programs. He asked Boehner to consider the timelines for the Centers for Medicare & Medicaid Services’ e-prescribing, meaningful use and physician quality reporting programs, saying that physicians don’t deserve to be penalized for choosing to participate in and prioritize one incentive program over others.

This article is a brief and relatively superficial examination of the ICD-10 issue. In fact, transition from ICD-9 to ICD-10 represents a complex and controversial undertaking. Diagnosis Detail discusses some questions about the relative value and costs of the effort. There are many questions about the regulatory and practical aspects of this initiative. I recommend the article and my earlier post on the subject as good starting points.

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