AMA: Delaying the implementation of ICD-10 is a win for doctors

AMA: Delaying the implementation of ICD 10 is a win for doctorsA guest column by the American Medical Association, exclusive to KevinMD.com.

It will come as no surprise to many of you that it can take a very long time to get things accomplished in Washington, D.C. However, a recent policy change from the Department of Health and Human Services (HHS) shows that when physicians join together for a common cause we can make a difference. Since November, the AMA has been working to stop the implementation of ICD-10, a cumbersome new diagnostic code set. Our efforts produced real action – HHS recently announced that there will be a delay in the transition to this new system.

The implementation of ICD-10 was scheduled to occur on October 1, 2013. The transition to ICD-10 would require physicians to adjust to an overwhelming 68,000 codes, significantly higher than the 13,000 currently used in ICD-9. The timing of this transition could not be worse for physicians, who are already investing significant time and resources to successfully meet multiple new Medicare requirements like e-prescribing, the meaningful use of electronic health records and the Physician Quality Reporting System.

Not only is timing an issue with ICD-10, but so is the high cost. The expense of implementing ICD-10 could range from $83,000 for a group of three physicians, to $2.7 million for a large practice of 100 physicians. A change of this magnitude would require a significant financial investment as well as staff training and new software.

Because of these concerns, the AMA’s House of Delegates passed policy opposing the implementation of ICD-10 in November 2011. The AMA took this strong message from physicians to the administration, asking the government to stop implementation of ICD-10. We stated our concerns about the timing and cost and told them that a transition of this magnitude would take physicians’ time and resources away from treating patients.

We invited Marilyn Tavenner, acting director of HHS’ Centers for Medicare and Medicaid Services (CMS), to speak before 500 physicians and medical students gathered in Washington a couple of weeks ago for the AMA’s National Advocacy Conference (NAC). She announced that she had heard our concerns and would re-examine the pace of ICD-10 implementation. Just as important, the administration also communicated that they would work with physicians to find a way to alleviate unnecessary administrative burdens and provide an environment that is conducive for quality patient care.

The administration’s swift reaction to the AMA’s concerns regarding ICD-10 is a powerful example of what can happen when we join together and make our voices heard in Washington. The AMA will keep up this momentum so that the administration understands the burden on physicians not only caused by the implementation of ICD-10, but other CMS programs as well.

There are still many issues, like the broken Medicare physician payment formula, that need attention. Congress again delayed the Medicare physician payment formula by putting another short-term patch in place, but missed another opportunity to permanently eliminate this formula. We are pleased to see members of Congress from both sides of the aisle are working together to address this issue, but swift action is needed now to stop the 32 percent cut scheduled for January 1. Join us in communicating on these and other important federal issues by becoming a member of the Physicians Grassroots Network.

Peter W. Carmel is President of the American Medical Association.

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  • Steve Sisko

    I think Dr. Peter Carmel is a bit presumptious to credit the AMA with the recent decision to look at delaying ICD-10 and he may be suffering from premature articulation: ICD-10 is not being stopped and I have not read any statement from the government stating their decision to take a look at changing the ICD-10 implementation date is directly related to anything the AMA has done.

    In fact, I suspect the delay might be more related to CMS’s own systems remediation challenges and the recent 5010 implementation.  But, like Dr. Carmel, I have no direct proof as to what CMS’ real reason for looking at the delay.

  • http://www.facebook.com/people/Ardella-Eagle/840440226 Ardella Eagle

    Love ‘em or hate ‘em, the AMA is working for its constiuents. There are so many broken bits to the system, but slowly and surely things will get done.

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Off-topic Kevin, but I hope you can cover this.

    http://online.wsj.com/article/SB10001424052748703819904574555723216593610.html

    When patients visit some doctors’ offices and urgent-care
    clinics, they’re increasingly running into something unexpected: billing as
    though they had gone to a hospital.

    The fees, which sometimes amount to hundreds of dollars, can
    result when hospitals own physician practices, urgent-care centers and other
    operations. Patients visiting an urgent-care clinic for a sore throat, for
    instance, can unexpectedly get billed as if they visited a hospital emergency
    room. And doctors’ offices in clinics owned by hospitals, besides billing for
    the physician’s work, might also tack on a “facility fee,” an
    additional charge hospitals usually impose when procedures are done on their
    premises. Even for insured patients, such additional charges can drive up
    out-of-pocket costs.

    Avoiding Extra Charges

    Some consumers are unexpectedly being charged hospital fees
    when they visit urgent-care centers and doctors’ offices that are affiliated
    with hospitals. Here are some steps you can take to protect yourself from
    paying too much:

    Insurers, including WellPoint Inc. and Cigna Corp., say
    they’re seeing an increase in hospital facility fees charged when members see
    doctors in clinics affiliated with hospital systems. Rick Weisblatt, a senior
    vice president at Harvard Pilgrim Health Care, says the issue is “the
    expansion of hospital services far from their campus, but still billed” as
    if they were offered in the hospital’s main building. Harvard Pilgrim estimates
    that doctor visits at independent urgent-care facilities cost around $24 to
    $185, while at clinics that are considered parts of hospitals the tab would be
    about $69 to $541.

    (see the full article)

    If you Google the article headline, in this case “When Hospital Fees Catch You Off Guard”, you can usually get around their subscriber thing on a one-time basis and read the individual article.

    This is example number seven bazillion of how the hospitals build up the doctor groups, not because of any economy of scale or any particular business savvy, but pure and simple, because they can extract much higher fees for the same service. They are NOT more efficient than the small practice, but in fact are LESS efficient and cost LOTS more.

    • Anonymous

      This is the crassest, most blatant rip-off going these days. Those who lead our medical societies are frequently beneficiaries of this scam, yet they still preach to the rest of us about cost-effective medicine.

      One assumes that the large insurers have contracts with these large hospital conglomerations, so the “facility fee” must be an allowed charge?

      I’m not sure what’s going on, but if I added a facility fee to my claims, it would be denied in a New York minute and the patient wouldn’t have to pay it. So at some level, the insurers are allowing this to happen (haven’t been able to access the article yet, so don’t know if this is covered in it.) 

      • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

        The hospital-owned facilities in my area, the primary care clinics and the Urgent Care clinics that compete with me, charge……and get…..twice my fee for the same work.

        I’ve worked at their facilities, and I’ve seen their fee schedules in black and white. I’ve seen their facility fee price add-ons.

        I know a receptionist who was fired…….maybe strongly encouraged to leave voluntarily. She got sick and tired of getting yelled at by outraged patients. She warned the patients of the price.

        The clinic gets a patient who needs suture or staple removal, put in elsewhere. Imagine someone getting a laceration on vacation elsewhere, its time to take the sutures out, but patient is back home. Or surgery done at University mecca, surgeon said it was OK to remove staples on day “X”, and patient shows up just for that.

        Next thing you know, uninsured patient, or even insured patient with big deductible, gets hit with a $300 bill for suture removal. Receptionist warned patient, who had sticker shock, and ran out of the office, looking for a needlenose pliers or the niece who works at a nursing home.

        Contrary to claims you see around here, these big box places are actually LESS efficient, and cost significantly MORE for the same work.

        • Anonymous

          If insured patients are getting hit with these ridiculous charges, it means that their insurers have agreed to these fee schedules. That’s the source of the problem.

  • Chris OhMD

    How did you come up with $83K for group of 3 docs to transition to ICD10?

    Thanks.

  • http://profile.yahoo.com/GJ4KICD3SWDQVEIQTCHESON2XI Lisa Hawthorne Crall

    I am a coder in HIM and while this is going to be costly,I sincerely believe it will be beneficial in the long run.  ICD-9-CM has lots of holes in it, and if a physician isn’t familiar with the ins and outs of it, money can literally walk out the hospital/office door.  Something as simple as adding the word “acute” to a diagnosis (when in fact it is) can bring in more allowable money, and the physicians and facilities should be paid for what they are treating. Another common problem we see is failing to add the word “excisional” to a debridement procedure (can be a $6,000 loss).  It can get to splitting hairs.  The system as it is set up presently is very frustrating to deal with at times.
      I am getting my ICD-10 training as I write this.  It will definitely be interesting to see how this plays out.

  • Anonymous

    A fundamental principle of quality process improvement is ignored in the title of the article.  To “delay” a process that embodies serious problems is not a “win” by quality metrics. Problems need to be fully corrected, and this involves identifying and effectively addressing root causation. The fundamental understanding that treating symptoms rather than root causation will often result in worsened long term outcomes despite otherwise good intentions is driven home to medical professionals early in their educational experiences. This same understanding does not manifest itself across a majority of bureaucratic and  legislative/regulatory initiatives. Further, this lack of wisdom is reflected acrosss the full spectrum of concerns contained in the ACA. Unfortunately, the long term results will be suboptimal.

  • Anonymous

    I am a HIM professional who works for a large multi-specialty physician group comprised of 300+ physicians.  I feel compelled to set the record straight on ICD-10 for any physician/health care professional who may have read the AMA article listed on this site that a delay in ICD-10 is a “win” for doctors.

    I think we can all agree that there are problems with our healthcare system – no news there, but to get us moving forward (not backwards) we need to implement ICD-10 in the current time frame of October 1, 2013.  

    ICD-9 is over 30 years old and frankly very outdated – it cannot be expanded to capture new diseases, technology or to describe what is truly wrong with the patient by using terminology utilized by modern day physicians.  ICD-9 is not descriptive enough to support any new reimbursement models.  More and more it appears that new reimbursement models will be outcomes based.  ICD-9 cannot support outcomes based reimbursement. 

    Yes ICD-10 has 68,000 codes but really no single physician uses all 14,000 codes in ICD-9 today.  There is nothing to be afraid of – there is no requirement to use all 68,000 codes in ICD-10.  The same type of patient you see today will not change come October 1, 2013. 

    ICD-10 will be able to support any new reimbursement models the government and private payers throw at us and ICD-10 is descriptive enough that eventually we will not need to submit all the additional supporting documentation we do today to get a claim paid.  This means lower overhead costs for a physician practice.   

    As far as the cost of ICD-10 implementation – our costs are more in the range of the AMA estimate for the 3 physician practice than the 100 physician practice.  Our goal as HIM professionals in charge of our Group’s ICD-10 implementation is to make it seamless for our physicians – so that October 1, 2013 is like any other day.

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