Health Information Management

Arguments for ICD-10 delay see little support at Congressional hearing

APCs Insider, February 13, 2015

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By Steven Andrews
Last year's unexpected ICD-10 delay disappointed countless hospitals, payers, physicians, and other stakeholders who had dutifully prepared for implementation only to see a clause slipped into an unrelated bill without debate disrupt their plans.
When given a chance to speak before the House of Representatives' Subcommittee on Health Wednesday, six of the seven stakeholders present voiced strong opposition to another delay. The panel's lone voice of dissent struggled to find arguments that weren't quickly undermined by fellow witnesses.
The witnesses were:
  • Edward M. Burke, MD, Beyer Medical Group, a small practice with two doctors and three nurse practitioners
  • Rich Averill, director of public policy, 3M Health Information Systems
  • Sue Bowman, senior director of coding policy and compliance, AHIMA
  • Kristi A. Matus, chief financial and administrative officer, Athena Health
  • William Jefferson Terry, MD, practicing urologist, on behalf of the American Urological Association
  • Carmella Bocchino, executive vice president of clinical affairs and strategic planning, America’s Health Insurance Plans
  • John Hughes, MD, professor of medicine, Yale University
When polled by the subcommittee's chairman, Terry was the only witness to say the industry was not ready and Congress should consider further delays. "I'm concerned about patient care, I don't care about the costs," he later said.
He made that statement despite frequently using cost as one of ICD-10’s major burdens. When other witnesses cited the most recent survey of ICD-10 costs for physician offices, which showed much lower costs than previously estimated, Terry argued it should be disregarded since it was conducted by members of the Professional Association of Health Care Office Management (PAHCOM).
Instead, he promoted an "independent" study by Nachimson Advisors that shows vastly higher costs and actually infers a delay would be more costly than implementation, per year. Terry neglected to note this study was paid for completely by the AMA, which has been fighting ICD-10 for years, and for whom he serves as a delegate.
Terry also complained of the burden of physicians having to learn so many new codes with ICD-10, undermining their ability to care for a patient. Never mind that many physicians employ professional coders to take on that task or outsource it. Burke rebutted that point by stating that the only unexpected part about switching to ICD-10 early was how easy it was. There was no interruption to patient care; it was business as usual even though his practice was using 10%-20% more codes in ICD-10.
Terry argued that the number of codes we will use compared to other countries that have implemented ICD-10 is staggering, and not supported by the medical community. In reality, nearly half of those additional codes simply relate to laterality, according to Bowman. Those codes are so useful the World Health Organization is considering adapting the concept for ICD-11, she added.
Averill noted that much of the specificity has been driven by the medical community, in open meetings between CMS and other healthcare representatives. The American Urological Association, which Terry represented, has even requested at least 200 additional codes for the first update to ICD-10 to include details about additional diagnoses, Averill said.
The subcommittee members agreed the industry needs to move to ICD-10, but some still resisted committing to a 2015 implementation date. Larry Bucshon, R-Indiana, a former cardiac surgeon, claimed "the individual physician out there will not be able to do this." He dismissed the testimony of any witnesses who were not practicing physicians, saying he was disappointed they were making claims that simply weren't true about the effect of implementation.
When Hughes extolled the virtues of more specific data for research and clinical purposes via ICD-10 codes, Buschon said patients and physicians wouldn’t see any short-term benefit before conceding there may be long-term benefits. He failed to recognize that by repeatedly delaying implementation, the government has only pushed those benefits further into the future.
Will ICD-10 cause at least some level of disruption for everyone from the single-physician office to the large hospital system? Absolutely. That's unavoidable with such a fundamental change. However, the industry has spent many years and a lot of money to prepare. Further delays only punish those who followed CMS' timelines and prevent the benefits for patients.
The biggest problem surrounding ICD-10 right now is uncertainty, Averill said. Hopefully, Wednesday’s hearing convinced the subcommittee of the damage Congress has already done to the industry and it won't try to sneak in any further disruptions before October 1.


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