Updated on: March 17, 2016

AMA to Congress: Halt ICD-10

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Original story posted on: January 29, 2012

Citing “significant burdens on the practice of medicine with no direct benefit to individual patient care,” James Madara, MD, executive vice president and CEO of the American Medical Association, is urging Congress to stop the implementation of ICD-10 mandated for all HIPAA-covered entities by October 2013.

 

In a Jan. 17, 2012 letter from Madara to House Speaker John Boehner, Madera wrote that physicians would have to bear the cost of implementing ICD-10 “without any financial aid from the government.” He noted that, depending on size of the medical practice, “the total cost of implementing ICD-10 ranges from $83,290 to more than $2.7 million.”

“It’s unfortunate the arguments against ICD-10 are focused purely on cost and don’t address the wealth of available material describing the benefits of this new standard for diagnosis and procedure codes,” Ian Bonnet, vice president of WellPoint, argued in a written statement to ICD10monitor. “Physicians and hospitals will have better information about their patient populations for use in quality and outcomes-focused programs. Patients who would benefit from care management programs will be better identified for those programs that can improve their health.”

Madara stated that implementing ICD-10 would be a “massive administrative and financial undertaking for physicians, requiring education, software, coder training and testing with payers.”

“Many in the physician, hospital and payer communities have already taken necessary steps to prepare themselves to begin to submit claims to CMS and other payers under ICD-10 well in advance of the official October 2013 date, spending substantial amounts on assessments, education and preparation,” said Chris Powell, president of Precyse. “Providers and industry experts have also expressed that postponing will be more expensive and cause more rework.”

On the other hand, Rudy Braccili, executive director of revenue cycle services for Boca Raton Regional Hospital in south Florida, said if the AMA were to be successful in postponing the implementation of ICD-10, it would be a “tremendous financial relief for hospitals across the nation – to the tune of millions of dollars per hospital – at a time when providers are facing declining revenues, increased costly regulation and significant retrospective payment retractions by governmental auditors, which often prove erroneous upon appeal.”

Madara in his letter to Boehner acknowledged the number of other healthcare initiatives facing physicians and called on the speaker to “synchronize” those initiatives. “We urge Congress to consider a reasonable, sequenced timeline for these penalty programs,” he wrote, “so that physicians are able to meet the various program requirements to avoid penalties.”

“We need to forge ahead, because better clinical quality cannot wait,” Powell countered.

“At Cleveland Clinic Health System, we have concluded that ICD-10 will benefit our patients’ care,” said Lyman Sornberger, executive director of revenue cycle management for the Cleveland Clinic Hospital System. “As a result, we will embrace the new process with … enthusiasm to support our patients’ wellness.”

The tone and content of Madara’s letter reflects the Nov. 15, 2011 announcement by AMA, which urged a halt to implementing ICD-10.

"The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients' care," said Peter W. Carmel, M.D., AMA president. “At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions.”

As to be expected, CMS is resolute in its position concerning the efficacy of ICD-10.

“As we have previously stated, implementation of this new coding system will mean better information to improve the quality of health care, and more accurate payments to providers,” said a CMS spokesperson. “CMS is giving significant transition time and flexibility to providers to switch over, and we will continue to work with the health care community to ensure successful compliance.”

Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.