Health Information Management

Costs, transition plan focus of House hearing on ICD-10

HIM-HIPAA Insider, February 16, 2015

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Implementation costs and plans took center stage at The House Energy and Commerce Committee’s subcommittee on health’s ICD-10 Implementation hearing February 11.

Seven witnesses testified before the subcommittee about the benefits and downsides to ICD-10 implementation. Members of the committee then asked witnesses a wide range of questions about ICD-10.
Six of the witnesses were pro-ICD-10. The lone voice against ICD-10 came from William Jefferson Terry, MD, a practicing urologist from Alabama who represented the American Urological Association.
The committee members weren’t as pro-ICD-10 as the witnesses. Interestingly enough, though, most of them admitted we need to move to ICD-10. They just didn’t say when. Rep. Kathy Castor (D-Florida) did urge no more delays and Rep. Chris Collins (R- New York) said we should get ICD-10 sooner rather than later.
Not surprisingly, the cost of the transition came up repeatedly and the projected costs varied widely. Edward M. Burke, MD, from the Beyer Medical Group in Missouri, told the subcommittee that his small practice (two physicians and three nurse practitioners) was already using ICD-10 and they had no problems making the switch. He also said they incurred no additional costs. Their software vendor handled all of the transition work.
“We did not have special training,” Burke said. “We did not spend ANY money in preparation. We did not see less patients and our practice did not suffer. As providers, it was not frustrating or scary. It just was.”
On the other end of the spectrum was Terry, who said he would have to spend $5,000 if he wanted to attend ICD-10 training. (I’m not sure where he came up with that number. I’ve seen training, including HCPro’s Boot Camps, for a lot less money.)
Rich Averill, director of public policy for 3M Health Information Systems, brought up the just-published Professional Association of Health Care Office Management (PAHCOM) survey that put the costs of implementing ICD-10 for a small practice at approximately $8,000. He also mentioned that two other recent studies put the costs even lower. He didn’t name them, but I’m guessing that one is the 3M study published in the Journal of AHIMA.
Terry countered later in the hearing that the PAHCOM study probably wasn’t reliable since it was done by PAHCOM surveying its members. He cited the Nachimson study that estimated small physician practices will spend $56,639-$226,105 on ICD-10 implementation. He called that study “independent” even though AMA paid for it. No one called him on that.
Transition plan
Terry said his biggest concern, though, was not the cost. At one point, he even said he didn’t care about the cost. He’s worried that implementation will be a disaster. Not a completely unfounded concern given some other very high-profile healthcare implementations that didn’t go smoothly.
ICD-10 has the “potential to do irreparable harm to patients and physicians” if it is not implemented correctly, Terry said. He pushed for a dual coding system so that physicians have a year to get used to using ICD-10 before they get penalized for wrong codes.
I thought it was very interesting how he kept coming back to the idea that physicians shouldn’t be penalized if they code incorrectly in ICD-10. My first thought was, well, you get penalized if you code wrong in ICD-9. Why should you get a pass in ICD-10?
I understand his concern. We’ve been hearing for years about how small practices need to stash money away to carry them through any bumps in the transition. (Not sure how many small practices can afford to put money aside, but if you had started putting a little bit away three years again, you’d be in decent shape now.)
I think some small practices will go out of business. No one really wants that to happen, but I think it will because not everyone is prepared. Not everyone will be ready October 1, 2015. We would still have people not ready if we pushed implementation to 2016, or 2017, or beyond, for that matter.
I think his dual coding plan is a bad one. He proposed allowing physicians to decide whether to use ICD-9-CM or ICD-10-CM. He said physicians should get a year to practice with ICD-10 before they are forced to use it. Frighteningly enough, several of the subcommittee members embraced that idea.
Here’s the thing. People will procrastinate. It’s human nature. If you don’t give people a drop-dead deadline, they put it off. If we did implement dual coding, who’s to say physician practices would actually use that time to prep for ICD-10?
The other problem I have with running dual coding systems is that it puts an unnecessary burden on the payers and researchers. Payers would have to keep two systems running to deal with the practices that don’t want to use ICD-10. They in essence would be doing double duty. That’s not fair. (I can’t believe I am sticking up for payers.)
Dual coding will also hinder research, which was another big topic of the hearing. Better data from ICD-10 means better tracking, better research, and eventually (not immediately) better patient care. If different people are using different systems, the data becomes less useful.
Everyone on the subcommittee and all of the witnesses agreed we need ICD-10. So let’s end the suspense and make October 1, 2015, THE date.
This article originally appeared on HCPro’s ICD-10 Trainer blog.

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