Physicians oppose transition to ICD-10 altogether after a new AMA study reveals costs for implementation are triple the original estimates
By now, most clinical laboratory managers and pathologists know that the date for implementing ICD-10 was pushed back by one year. This happened when Congress enacted a temporary fix to the Medicare Sustainable Growth Rate (SGR) with enactment of the Protecting Access to Medicare Act (PAMA) last April.
Currently, the federal law calls for implementation of ICD-10 to happen on October 1, 2015, according to a report published by Journal of AHIMA, a publication of the American Health Information Management Association (AHIMA). Despite this delay, some powerful medical associations remain opposed to the adoption of ICD-10.. Among their objections is the substantial cost for physicians to move from ICD-9 to ICD-10.
Congress Delayed ICD-10 for Second Time to Appease Physicians
This was the second time ICD-10 implementation had been delayed. The original compliance date of October 1, 2013, had been pushed back a year earlier by the Center for Medicare and Medicaid Services (CMS) after some provider groups expressed “strong” concerns about their ability to meet the compliance deadline and the serious claims payment issues that might ensue.
The action by Congress to further delay implementation of ICD-10 not only rankled the AHIMA and American Hospital Association—because both groups had opposed the last delay—but it came as surprise to CMS Administrator Marilyn Tavenner, who had announced the previous month at the Health Information and Management Systems Society Annual Conference, that “there will be no change in the deadline for ICD-10.” Insertion of the ICD-10 delay clause into the PAMA law was done to placate physicians groups, noted a number of healthcare experts. This included the American Medical Association (AMA), which had opposed the PAMA bill and is also against moving to ICD-10 entirely.
AMA Study Reveals ICD-10 Costs to Physicians Triple Earlier Estimates
It was the AMA that sponsored a study about the costs of converting physicians to ICD-10. The study concluded that large medical practices may have to spend up to $8 million to implement ICD-10, nearly three times as much as was previously estimated. This research was done by Nachmison Advisors. It updated a previous report of cost estimates for physician practices transitioning to ICD-10.
“The markedly higher implementation costs for ICD-10 place a crushing burden on physicians, straining vital resources needed to invest in new health care delivery models and models and well-developed technology that promotes care coordination with real value to patients,” declared AMA President Ardis Dee Hovensaid, M.D. “Continuing to compel physicians to adopt this new coding structure threatens to disrupt innovations by diverting resources away from areas that are expected to help lower costs and improve the quality of care,” noted Hovensaid.
In a letter to the Health & Human Services Secretary, AMA CEO and Executive Vice President James Madara, M.D., urged reconsideration of the ICD-10 mandate. He pointed out that the transition represents the largest technical, operational and business implementation in the past several decades because it will require physicians and their office staff to contend with 68,000 diagnosis codes. That is a five-fold increase from the approximately 13,000 diagnosis codes currently in use.
Another concern by physician groups is the lack of preparedness for ICD-10 implementation. As many as 38% of the more than 570 physician practices polled last January by the Medical Group Management Association admitted that they had not yet started ICD-10 implementation. Only 9% of groups surveyed had made “significant progress,” noted a report published by Information Week.
ICD-10 Delay Estimated to Cost Healthcare Industry Up to $6.6 Billion
Meanwhile, CMS estimated that another one-year delay of ICD-10 is likely to cost the healthcare industry an additional $1 billion to $6.6 billion on top of the costs already incurred from the previous one-year delay, noted the AHIMA Journal report. This estimate did not include the lost opportunity costs for failing to move to a more effective code set.
Additionally, the delay impacted 25,000 students, who have been taught to code exclusively in ICD-10, as well as hospital and physician offices that had begun moving into the final stages of the costly and comprehensive transition to the new code set.
M. Alexandra Johnson (pictured above), a consultant at Chicago-based Coleman Consulting Group, says that transition to ICD-10 will be highly disruptive initially, but in the long run, will facilitate use of data to create a healthier population and make healthcare delivery more efficient. (Photo copyright Coleman Consulting Group)
Clinical laboratories and anatomic pathology have a big stake in successful transition to ICD-10. Medicare Part B claims for medical laboratory tests must be submitted with an appropriate ICD code provided by the physicians who ordered the lab tests. Lab test claims without an appropriate ICD code will not be reimbursed by the Medicare program.
Dark Daily readers are reminded that precursor systems that evolved into the ICD system emerged prior to 1900. It was ICD-6, issued in 1949, that was the first version to have an effective arrangement for morbidity reporting. Until ICD-6, the system was primarily used by participating countries for reporting mortality.
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 last developed nations to adopt ICD-10.
As a final note, ICD-11 is scheduled to be released during 2017. A beta version of ICD-11 has been available online since 2012. Countries around the world that have used ICD-10 for more than two decades are expected to move expeditiously to adopt ICD-11.
—Patricia Kirk
Related Information:
Senate Passes ICD-10 Delay Bill
ICD-10 May Cost 3X More than Estimated, AMA Says
The Cost of Implementing ICD-10 for Physician Practices
International Statistical Classification of Diseases and Related Health Problems
