On Nov. 10, the American Medical Association’s House of Delegates approved a policy opposing implementation of the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10-CM) at a policy meeting in New Orleans. Following the vote, Robert M. Wah, MD, AMA board chair, stated, “The AMA will work vigorously to stop implementation of ICD-10, which will create a significant burden on the practice of medicine with no direct benefit to individual patients’ care.”
Organizations tied to hospitals, however, are fully supportive of the switch.
“We strongly support ICD-10 and the enhancements it will bring to the care that’s provided in hospitals,” says Don May, the American Hospital Association’s (AHA) vice president for policy. “The current coding system has really run its course in its ability to keep up with modern medicine.”
SHM has taken a “neutral” stance on this issue, for the time being, says SHM’s AMA delegate Bradley E. Flansbaum, DO, MPH, SFHM, director of hospitalist services at Lenox Hill Hospital in New York City. “But [SHM is] cautiously optimistic as the inpatient ecosystem evolves, hopefully, for the better.”
History of Opposition
In 2003, the AMA wrote to the National Committee on Vital and Health Statistics regarding plans to adopt ICD-10. The 55 signees of the letter (including the American College of Surgeons and other specialty societies) urged the committee to “confine your recommendation [to HHS] to the uses of ICD-10-PCS [the procedural codes portion] as a coding system for inpatient hospital services.” Another letter in 2006 to Bill Frist, then the U.S. Senate majority leader, expressed concern over a “rapid transition” from ICD-9 to ICD-10.
The AMA contends that switching to ICD-10 disproportionately burdens physicians in practice. “Depending on the size of a medical practice,” Dr. Wah says, “the total cost of impact of the ICD-10 mandate will range from $83,290 to more than $2.7 million. Physicians should not be expected to carry a disproportionate burden of the implementation costs when others in the health sector stand to reap the primary financial benefits.”
Upgrade: The Time Has Come
Organizations in support of the changeover, however, see the implementation of ICD-10 coding as a necessary step forward in improving patient care.
—Robert M. Wah, MD, board chair, American Medical Association
“It’s not unreasonable to replace a 30-year-old, out-of-date system,” says Sue Bowman, RHIA, CCS, director of coding policy and compliance with the American Health Information Management Association (AHIMA). Bowman says she is surprised that the AMA maintains the switch will not benefit patient care. “Everything nowadays has to do with healthcare data,” she says. “Without good data, you cannot measure quality of care, patient outcomes, or effectiveness of treatments. The expectation is that ICD-10 will better mirror the terminology already used in medical records.”
May agrees. “We understand the concerns,” he says, “but if you think about how much better we’ll be able to track disease and how it affects patients, there will be a much more rich data set at our disposal. This will help us develop evidence-based medicine and quality standards in a much more robust way than we can do today.”
In addition, May says, hospitalists may be able to function as a “huge resource” to their community physician colleagues, to help them understand the benefits of making the switch, and help them find the short cuts to manage the new system.
AHIMA is aware, Bowman notes, that some physician groups “were struggling with moving forward with ICD-10, but our message to the industry is for people to continue working toward implementation. CMS has made it pretty clear that there’s not going to be a delay or a grace period.”
In response to the AMA action, a spokesperson for CMS says, “Implementation of this new coding system will mean better information to improve the quality of healthcare, and more accurate payments to providers. CMS is giving significant transition time and flexibility to providers to switch over, and we will continue to work with the healthcare community to ensure successful compliance.”
Gretchen Henkel is a freelance writer based in California.