Health Information Management

Congress continues tone-deaf approach to ICD-10

APCs Insider, May 8, 2015

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By Steven Andrews
Several members of Congress showed a fundamental misunderstanding of ICD-10 during a subcommittee hearing in February, failing to understand the legislative body's role as a major deterrent to training and education and dismissing wide swaths of expert testimony about industry preparedness.
For example, during the hearing Rep. Larry Bucshon, R-Indiana, a former cardiac surgeon, claimed that witnesses who weren't practicing physicians were spreading false claims about the effects of implementation.
Congress should have been listening when Rich Averill, director of public policy for 3M Health Information Systems, astutely noted that the biggest problem providers face regarding ICD-10 is the uncertainty about an implementation date. Congress contributed to this with its 2014 delay.
A recent WEDI survey of more than 1,100 stakeholders proved Averill's point. Continued fear over more delays was chosen as the biggest obstacle to implementation by more than 50% of respondents.
I guess Rep. Ted Poe, R-Texas, didn't have time to review all the testimony from the hearing showing overwhelming industry support for October 1, 2015, implementation since he introduced legislation last week seeking an apparently permanent ICD-10 delay, effectively killing it for good.
The text of the bill is not yet available, but he likely echoed his previous attempt to delay ICD-10 with the Cutting Costly Codes Act of 2013. The new bill is also likely to share the same fate of his 2013 bill, which didn't even make it out of committee.
In addition to delaying ICD-10, his previous legislation called for a Government Accountability Office (GAO) report on how risks associated with the transition could be mitigated for stakeholders. Well, in the time since his first bill died due to disinterest, GAO did prepare that report.
GAO concluded that CMS should perform comprehensive testing and expand its training opportunities. CMS has done that with successful end-to-end testing and ICD-10 resources specifically tailored to practices of size and various specialties.
But Poe still shows that fundamental misunderstanding of ICD-10 endemic among many in Congress.
“The new ICD-10 codes will not make one patient healthier,” said Poe in a press release touting his new bill. “Instead of hiring one more doctor or nurse to help patients, medical practices are having to spend tens of thousands just to hire a specialist who understands the new codes."  
Poe apparently believes in some heretofore unknown healing powers of the current ICD-9 code set and that providers are choosing between hiring additional clinical staff or paying the same amount to specialists who are able to divine the meaning of ICD-10 codes. I'm not sure what he thinks current coders, who have trained for years on ICD-10, are going to be contributing in this scenario.
Apparently he missed the 2015 member survey from AAPC. "Many respondents also stated that ICD-10 implementation has not been as hard as they thought it would be, and that overall it has improved processes and documentation in their practices," according to the survey.
It's probably no surprise that Poe's rhetoric echoes that of the Texas Medical Association, which has supported previous delay attempts and frequently contributes to his campaigns and those of his Texas-based cosponsors.
Poe repeatedly takes the short-term view of the benefits of ICD-10. Sure, the codes aren't going to prove valuable for data collection on October 5. But as information accumulates, providers and researchers will have much more specific data to follow diseases processes and determine better treatments.
Likewise, proficient coding in ICD-10 could lead to better long-term cash flow for providers by reducing the number of unspecified codes and better capturing how sick patients truly are. This information will only become more valuable as CMS continues to transition toward paying for quality care over volume.
Providers shouldn't let Poe's bill contribute to any uncertainty they have about October 1, 2015, being the deadline for an ICD-10 transition. He currently has only six cosponsors and no bipartisan support. Especially considering Congress has been remarkably ineffective at doing its job over the last several sessions, the chances this bill go anywhere are minimal.
That doesn't mean providers should let Poe get away with his continued push for a delay. Contact him through Twitter or Facebook and let him know that his efforts actually have a negative effect on preparedness and the best thing he can do is support the industry as it makes this transition.

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