AMA opposition to ICD-10 deadline moves HHS to reconsider, while leaving some transition-ready providers rankled

When it comes to implementation of ICD-10 in the United States, the “do it later” crowd seems to have convinced the Department of Health and Human Services (HHS) of the need to once again move back the compliance date for ICD-10. On April 9, HHS announced a proposed rule to defer implementation by one year, with a new effective date of October 1, 2014.

Clinical laboratories and anatomic pathology groups have a big stake in a successful transition from ICD-9 to ICD-10. Among other reasons, Medicare Part B claims for medical laboratory  tests must be submitted with an appropriate ICD code [provided by the physician who ordered the lab tests] for the clinical lab or pathology group to be paid by the Medicare program.

“HHS believes the change in the compliance date for ICD-10, as proposed in this rule, would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments,” the agency stated in the fact sheet.

AMA Cites Bad Timing and High Costs in Opposing Original Deadline

The HHS decision to delay the compliance date came in the wake of strong opposition from the physician community. Last November, members of the American Medical Association (AMA) House of Delegates voted to resist the federally mandated adoption of the new code set, stated a story in Modern Healthcare (MH). Within three days, the Centers for Medicare and Medicaid Services (CMS) announced that it would back off of the enforcement deadline for the rollout of the ASC X12 Version 5010, a related set of healthcare electronic transmission standards. Version 5010 is deemed a prerequisite to ICD-10 adoption. The deadlines for both 5010 and ICD-10 transitions were set nearly three years ago, MH reported.

Physicians, hospitals, clinical laboratories, pathology groups, and other providers will have an additional year before they must comply with ICD-10. That’s because the Department of Health and Human Services has proposed a rule to defer implementation of ICD-10 by one year. Instead of October 1, 2013, compliance would be required as of October 1, 2014. (Graphic copyright by Advanceweb.com.)

The International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10) is part of the government’s ongoing effort to establish adopted standards for electronic health care transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The previous June, after polling its members on their 5010 readiness, the Medical Group Management Association (MGMA) called for CMS to create an alternative plan if practices were still struggling to comply as the original deadline loomed near. According to Robert M. Tennant, M.A., Senior Policy Adviser for the MGMA in comments to MH, it appears that may be one reason why CMS relaxed enforcement.

In a January 17, 2012, letter, to House Speaker John Boehner (R, Ohio), James L. Madara, M.D., AMA Executive Vice President and CEO, had argued that requiring doctors to use ICD-10 would offer no direct benefit to patient care. This was reported by the AMA News in a February 7 posting.

The timing of ICD-10 compliance pressures could not be worse for physicians, stated Madara. That is because physicians are already under the pressure of adopting Medicare-incentivized electronic medical records (EMR) and hustling to meet the requirements of quality reporting and value-based purchasing, while facing continuing Medicare rate cuts.

According to the story, Madara also cited high ICD-10 implementation costs as a factor in AMA’s opposition to the switch. He said AMA estimated the costs of implementing ICD-10 to range from about $83,000 to $2.7 million, depending on the size of the practice.

Not All Stakeholders Agree with AMA’s Call to Oppose ICD-10

“Stopping the implementation of ICD-10, and calling on appropriate stakeholders including physicians, hospitals, payers, national and state medical and informatics associations, to assess an appropriate replacement for ICD-9 will help to keep adoption of EMRs and physician participation in quality and health IT programs on track and reduce costly burdens on physician practices,” Madara wrote in the letter to Boehner.

Some providers, however, were rankled by the news of a delay. “I haven’t talked to anyone who isn’t extremely disappointed,” Susan Heichert, RN, B.S.N., F.H.I.M.S.S. Senior Vice President and Chief Information Officer at Allina Hospital and Clinics in St. Paul, Minneapolis, said during a press briefing at the February meeting of the Healthcare Information and Management Systems Society (HIMSS).

She was quoted in a story published by MedPage Today (MPT). The writer reported that, in a survey of 302 hospital IT executives presented at the HIMMSS conference, nearly 90% said they expected to complete their ICD-10 conversion by the October 2013 deadline. The story noted that the question had been posed to survey participants several months prior to the HHS announcement of the postponed deadline.

The American Hospital Association (AHA) is another organization that does not support the AMA’s opposition to ICD-10 adoption. “At this point we’re still supportive of ICD-10,” declared Don May, AHA Vice President for Policy in the MH article.

Providers, including pathologists and clinical laboratory managers, may or may not be pleased with the ICD-10 compliance delay, depending on the status of their readiness for the original deadline. In any event, all will have an additional year to meet the adoption requirements.

Finally, Dark Daily readers are reminded that ICD-10 was originally issued in 1992 by the World Health Organization (WHO). It has been adopted by most developed nations. Thus, the United States is one of the largest nations in the world yet to adopt and use ICD-10.

—Pamela Scherer McLeod

Related Information:

Revolt over IT requirements: AMA blasts ICD-10, while CMS relents on 5010

AMA calls on Congress to block ICD-10 mandate on doctors

Possible ICD-10 Delay Rankles IT Industry

Audio Conference on: HIPAA Form 5010 Implementation: Real-World Solutions to Ease the Transition from 4010 to 5010 and Avoid Reimbursement Delays

Many Clinical Laboratories, Other Providers Struggle to Transition to 5010; Likely To See Payment Shortfall