December 19, 2011

Roundtable Renounces AMA Opposition and Urges Physicians to Join the Renaissance


"Nothing has changed at CMS relative to I-10 implementation... We haven't been given any clue that the implementation date will move." That was the official word provided by Denise Buenning, director of the administrative simplification group at the Centers for Medicare & Medicaid Services (CMS) Office of E-Health Standards and Services, during the roundtable discussion, “At the Crossroads: AMA’s Impact on ICD-10,” produced by ICD-10monitor on Tuesday, Dec. 13, 2011.


Buenning and five other industry experts discussed the American Medical Association’s (AMA) November announcement that it “vigorously” opposes ICD-10 implementation and that it would work to stop it. In fact, Buenning said, CMS has developed “more traction on ICD-10,” and the other panel members agreed that that the AMA’s position has had no impact on their plans and that halting progress on ICD-10 implementation is a bad idea.

In addition to reacting to the AMA’s position, some panel members discussed strategies being used in their own organizations to bring physicians on board, and the representative from the Centers for Medicare & Medicaid Services provided insights into the agency’s position and progress. The following individuals joined the discussion:

  • David Block, MD, co-founder, Health Care Mediation, LLC
  • Ian Bonnet, WellPoint vice president of federal mandates for ICD-10
  • Denise Buenning, director of the administrative simplification group at the CMS Office of E-Health Standards and Services
  • Linda Kloss, president of Kloss Strategic Advisors, former chief executive officer of the American Health Information Management Association (AHIMA)
  • Kyle McElroy, director of health information, management operations, IASIS Healthcare
  • Lyman Somberger, executive director of revenue cycle management, Cleveland Clinic Health System

Note too that ICD-10 Monitor staff repeatedly asked AMA to send a panel representative, but the organization did not respond to the request.

Initial Reactions

However, several acknowledged that physicians are, as Bonnet pointed out, “getting squeezed” by the SGR [sustainable growth rate], IT [information technology] implementation, and other mandates.”

Kloss agrees that many initiatives are converging at the same time, adding that the AMA’s reaction is an “expression of frustration” with all of the changes coming at physicians, particularly the prospect of a significant fee reduction in 2012. She likens the variety of key changes converging to the “the perfect storm.” However, she also states that AHIMA is disappointed by AMA’s stance.

“Everybody needs to remember that this wasn’t a quick decision to move toward I-10. Many spent years thinking about this, and the AMA was involved,” she said. At the time, most of the AMA’s concerns related to the ICD-10 procedural coding system (PCS) and its scope. “When the decision was made to restrict it to the inpatient setting, the AMA seemed to be on board,” said Kloss.



Confronting the Roadblocks

Collaborating with physicians must be a prime goal for all involved. As Dr. Block says, “I encourage everyone to figure out how ICD-10 will benefit physicians and find out their individual or common interests.”

Dr. Block believes that hospital leaders must “initiate a dialogue, rather than just providing training and education or having suits parachute into the hospital and talk about I-10.” Hospital leaders and physicians must talk one-on-one about the system and determine how it will affect every-day practices and systems. “Don’t treat all physicians as a monolithic unit,” he says.

Kloss calls this a “change-leadership challenge,” and offers this advice: “Don’t bully everybody. Instead, create talking points and communicate with physicians and their staff.”

Somberger and his colleagues at Cleveland Clinic Health System look for “points of leverage.” Traditionally, he explains, the relationship of providers and payers has been “combative.” Now that is changing.

“We have taken a positive attitude [about ICD-10] with payers and providers. It’s the right thing to do, and we must collaborate. We must assess where we are in the process and how we can service each other,” he says. In the case of physicians, “We emphasize that the ICD-10 system will help them know more about patients’ clinical conditions, which will be an asset.”

One way to start the process is to introduce clinical documentation information (CDI) to physicians and have them work one-on-one with a CDI specialist. McElroy says, “Our clinical teams focus on leveraging the granularity of the [ICD-10] codes.”

With a CDI program, staff query physicians and ask for more clarity about a patient’s clinical condition. “To wean them into providing more detailed definition,” says Bonnet, the CDI specialist asks for more information and more clarification about the documentation provided by the physician.

Accurate Information

The panel members agreed that misinformation about ICD-10 is prevalent in the industry. For example, a November 28 article (“AMA hoping to stop ICD-10 use in billing”) says this: “The change would force practices to learn roughly 69,000 new codes.”

Inaccurate information such as this must be sorted out, says Kloss. “Physicians who use 20 diagnosis codes now will still use 20 diagnosis codes in I-10,” not several thousands of codes.

Buenning agrees, saying that I-10 is “a far-reaching story that has to be told,” especially to those on Capitol Hill. In fact, Buenning met with a staff member who works for a congressman who also is a physician. She and her staff explained I-10 to him, and, she said, his viewpoint “took a 180.” He left the meeting promising that he would use the information to “educate his superiors.”

Considering the Odds

What’s the probability of the AMA action actually changing the course and affecting lawmakers on Capitol Hill?

In reality, determining the AMA’s ultimate power on the Hill is unknown. However, Bonnet notes that the AMA has a “strong voice in D.C. and there are thoughtful, influential physicians in Congress.” He also notes that the conversation about halting ICD-10 implementation is happening, and “It just takes a strike of a pen to change things.”



But, he and the other panel member hope that the future will hold a thoughtful, balanced debate with discussion about the pros and cons. Nonetheless, Kloss reports that AHIMA and others are on the alert, as “all logic could be suspended with the political agenda.”

Parting Thoughts

One of the panel members suggested that the AMA was just trying to “create mischief” with its opposition, but that mischief will penalize the early adopters of ICD-10. Providers and vendors who have already made significant investments would lose out even if Congress decides just to delay the implementation.

In Bonnet’s opinion, “It’s taken years to get the momentum to get the industry moving. If we stop now, we may never get the momentum back. It’s a renaissance period—an opportunity to make evolutionary leaps, and use I-10 as a catalyst for change.”

The change is and will continue to be “scary,” says Dr. Block. “As a mediator, renaissance is the right word. Although these are times that are interesting, they are also scary. When people go through these times, they draw a line in the sand and they won’t budge from that. Collaborative bargaining is called for.”


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Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for and; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.