On Nov. 15 American Medical Association (AMA), the nation's largest physician association, took a vocal stand against ICD-10 implementation during its semi-annual policy making session.
“I think this is indicative of the level of frustration from the regulatory and financial pressures that physician offices and practices are feeling today,” says AMA Board Chair Robert Wah, M.D. “It’s really important not to take this in isolation. This requirement for ICD-10 implementation comes on top of a lot of other regulatory and financial burdens on physician practices.”
Robert Wah, M.D.
Since the passage of the American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act, a lot is being asked of physicians, says Dr. Wah, like tackling meaningful use requirements, and participating in patient-centered medical homes, accountable care organizations, and health insurance exchanges. With all these healthcare quality initiatives, AMA sees ICD-10 as only adding administrative expense and creating unnecessary workflow disruptions.
Another reason for AMA’s opposition to ICD-10 is the financial investment for physicians for the implementation, and as Wah says, a “lack of return on investment”. AMA cited a 2008 study as context that found that a small three-physician practice would need to spend $83,290 to implement ICD-10, and a 10-physician practice would spend $285,195 to make the coding change. “Physicians are seeing that maybe other people, the payers, the government, maybe research, will get a return on changing over to ICD-10, but physicians and patients have to make the investments,” says Wah. “Here someone else gets the return, and you have to make the investment; that’s hard to square.”
In response to AMA’s opposition, the American Health Information Management Association (AHIMA) on November 16 voiced its disappointment and encouraged the industry to move forward to comply with the original deadline, Oct. 1, 2013.
“We believe that ICD-10 is essential for a lot of the initiatives we’re moving forward with today because we need more up-to-date, contemporary healthcare data,” says Sue Bowman, director, Coding Policy and Compliance, AHIMA. “The data that gets externally reported and is used for analysis is in ICD-9 codes that is over 30 years old now. The structure is not designed for today’s medical care or demands for more detailed and specific data.”
AHIMA notes that a slowdown in implementation of an inevitable classification change will greatly add to both the cost of such a delayed implementation and the purchase and implementation of electronic health records and health information exchange, as well as the impact on the many changes occurring in the healthcare industry’s implementation of quality-based reimbursement.
Another reason for AHIMA’s disappointment with the AMA, Bowman says, is extensive public debate on ICD-10 has taken place for many years and everyone has already had opportunity for input. “We feel like all of that was done, and the government was very responsive to public concerns,” she says, “and now it’s time to move past that discussion and prepare for implementation.”
Bowman adds that CMS instituted a longer transition period than in the original proposed rule because of public concerns. She sympathizes with the AMA that the transition might prove difficult for providers, but says it is 10 years coming. She stresses that if the ICD-10 system had been implemented in the late 1990s then the problems created by constant delay would not be experienced today.
Wah says that AMA recent announcement is only one in the many requests for changes to the implementation schedule made by his organization, which has always been concerned about the implications of the ICD-10 transition, as well as HIPAA 5010 compliance. Wah says that in the coming weeks AMA will continue highlighting issue and will explore an appropriate replacement for ICD-9.
“I think there’s a lot of fear factor, fear of change and misinformation of the complexity of the process,” says Bowman. “CMS has provided a lot of free resources, and there have been a lot of free seminars; so I think there’s a lot of help out there to help the physician practices going forward to make this process less painful.”