Health Information Management

ICD-10 opponents mount last-ditch roadblocks to implementation

APCs Insider, May 22, 2015

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By Steven Andrews
Congress appears to have finally acknowledged the inevitability of ICD-10 implementation in 2015, but opponents of the code set continue to debate its efficacy by using dated, debunked, and hopelessly biased arguments in a desperate bid for a delay.
Last week, James L. Madara, MD, president of the AMA, sent a letter to Rep. Ted Poe, R-Texas, applauding his bill that would effectively kill ICD-10. "The timing of the ICD-10 transition could not be worse," Madara lamented, without a hint of irony. He apparently forgot that without the AMA pushing for delays for years, the industry might already be over the transitional growing pains—or that the uncertainty largely aided by his association's advocacy led to many of the problems with organizations' readiness.
This wouldn't be the first time the AMA's apparently bottom-line focused advocacy had a deleterious effect on the industry. It was less than 20 years ago that the group fought to prove there was an overabundance of physicians in this country before frantically reversing course.
Both Poe's bill and another calling for CMS to accept both ICD-9 and ICD-10 codes after October 1 are languishing, collectively picking up only three cosponsors since being introduced and having no bipartisan support.
Steven Stack, MD, the incoming president of the AMA, also launched a desperate salvo last week calling for the industry to wait for ICD-11. I could recount the reasons that's a bad idea, but maybe it's best to just quote an industry group that extensively studied ICD-10 and ICD-11 implementation and concluded, "skipping ICD-10 and moving directly to ICD-11 is fraught with its own pitfalls and therefore, based on current information available, is not recommended."
Who made this determination that so cleanly undercuts Stack's argument? That would be the AMA's own board of trustees, in a report presented by none other than Stack himself in 2013. In that light, Stack's latest plea comes across less as a logically considered point taking into account patients and providers and more like a child promising he or she will go to bed after watching just one more show—anything to delay the inevitable.
This last wave of ICD-10 interference includes an ill-considered report from the Heritage Foundation that relies time and again on outdated or questionable sources to build its arguments. One of the most-cited studies it uses to conclude ICD-10 is an unnecessary burden is a Nachimson Advisors report on implementation costs—funded by the AMA, no less—that's already been thoroughly questioned for its accuracy. 
The other study it leans on for determining costs and benefits is a 2003 Nolan Company report funded by Blue Cross and Blue Shield. To consider all of the changes to payments, policy, and the healthcare industry at large over the last dozen years, it goes without saying that using such an ancient report is a foolhardy exercise meant to distort the truth. Not that I'd be the first to accuse the Heritage Foundation of such tactics in pursuit of an agenda.
If you want recent proof from an actual provider about the burden of ICD-10, look no further than the February hearing in Congress where Edward Burke, MD, testified that his small practice was able to implement the code set with no added costs or productivity issues.
The Heritage Foundation showed it at least paid attention to that hearing, though, by quoting the testimony of William Jefferson Terry, MD, a practicing urologist from Alabama who represented the American Urological Association.
Terry was the sole voice of ICD-10 dissent among witnesses, and bemoaned the number and specificity of new codes—before another witness memorably pointed out that Terry's association alone had requested 200 additional codes for the first ICD-10 update.  
This cherry picking of data results in the Heritage Foundation concluding that CMS should delink ICD codes from reimbursement and simply accept both ICD-9 and ICD-10 codes after October 1. In its conclusion, the Heritage Foundation bucks tradition from the rest of the report and resigns to citing itself, writing, "Although the CMS claims that it would be difficult or impossible to process claims in both systems, it is unclear why that should be the case. There will be some period of overlap during the transition from ICD-9 to ICD-10. It therefore seems reasonable that such an overlap period could be extended."
This fundamental misunderstanding of the chaos that would ensue from claims perpetually crossing code sets—especially considering how ICD-10 can track episodes of care—just cements that the report was written with the conclusion decided and any information included solely to prove that point.
ICD-10 proponents have a simpler message: ICD-10 is coming, and the best way to mitigate the impact is to prepare coders, providers, and the rest of the staff now. Spreading this fear and doubt only undermines these efforts, has the potential to disrupt patient care, and becomes a self-fulfilling prophecy.

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