This past November, the American Medical Association and its House of Delegates voted to "work vigorously to stop implementation of ICD-10." This was, in a way, the newest shot in the battle over ICD-10 — a battle that has raged on for more than a decade. Now, more than two months later into the wintery months of 2012, the healthcare environment has found itself in a somewhat-heated debate over ICD-10 and its "go-live" deadline of Oct. 1, 2013.
The war over ICD-10 does not rest on ICD-10 alone, though. ICD-10's prerequisite, Version 5010 electronic transaction standards, has also been a factor.
One day after the AMA declared in November it would do everything in its power to stop ICD-10, CMS' Office of E-Health Standards and Services announced it would not initiate enforcement of Version 5010 for HIPAA-covered entities until March 31, 2012 — a delay of 90 days from the Jan. 1, 2012, target. The Medical Group Management Association-American College of Medical Practice Executives also recently said the current problems with the transition to Version 5010 could force physicians to close their practices and should be further delayed to June 30.
In January and February, AMA took their efforts one step further. They sent letters to House Speaker John Boehner and Department of Health and Human Service Secretary Kathleen Sebelius urging the ICD-10 initiative be halted. The AMA has argued the costs of ICD-10 will be onerous and crippling to physician practices, estimating it could cost physician practices from $83,290 to more than $2.7 million depending on the size of the practice. The AMA has not indicated a date of when ICD-10 should be mandated, but rather suggested HHS should call "on appropriate stakeholders, including physicians, hospitals and payors, to assess an appropriate replacement for ICD-9 within a reasonable timeframe," according to AMA CEO James Madara, MD.
However, not all healthcare groups have opposed the ICD-10 transition. The American Health Information Management Association, one of the main advocacy groups for HIM and the advancement of health information standards, urged the healthcare community to "keep moving on the ICD-10 transition" because a wait-and-see approach will force providers to inevitably miss the compliance date.
The American Hospital Association's Central Office also believes the transition to ICD-10 will be beneficial and will "allow for precise diagnosis and procedure codes, resulting in the improved capture of healthcare information and more accurate reimbursement." Although AHA said it recognizes there are several overlapping health IT initiatives, its members still support the adoption of ICD-10.
Paul Spencer, compliance officer for Fi-Med Management, says when he first became a certified coder in 1998, he was told ICD-10 would probably be coming by 2000. Now, ICD-10 will be coming 15 years after his certification. "The reason it was delayed was related to lobbying dollars to make sure it never saw the light of day," Mr. Spencer says. "Throwing lobbying dollars is not going to change this reality."
In the end, HHS and CMS have the final say. They have already delayed ICD-10 once. Previously, ICD-10 was supposed to go live on Oct. 1, 2011, but after earlier resistance, they pushed back ICD-10 to the current compliance date. CMS, in particular, has repeatedly said there will be no more delays and no grace period, even amidst the three-month postponement of Version 5010.
The ICD-10 compliance date is still more than 19 months away, which will give plenty of time for provider and HIM groups to draw more lines in the sand and pitch their cases for an ICD-10 delay. With a delay not imminent, though, hospitals, physicians and other healthcare providers may need to ask themselves: How will ICD-10 ultimately affect my productivity and bottom line, and is it worth waiting any longer?
The war over ICD-10 does not rest on ICD-10 alone, though. ICD-10's prerequisite, Version 5010 electronic transaction standards, has also been a factor.
One day after the AMA declared in November it would do everything in its power to stop ICD-10, CMS' Office of E-Health Standards and Services announced it would not initiate enforcement of Version 5010 for HIPAA-covered entities until March 31, 2012 — a delay of 90 days from the Jan. 1, 2012, target. The Medical Group Management Association-American College of Medical Practice Executives also recently said the current problems with the transition to Version 5010 could force physicians to close their practices and should be further delayed to June 30.
In January and February, AMA took their efforts one step further. They sent letters to House Speaker John Boehner and Department of Health and Human Service Secretary Kathleen Sebelius urging the ICD-10 initiative be halted. The AMA has argued the costs of ICD-10 will be onerous and crippling to physician practices, estimating it could cost physician practices from $83,290 to more than $2.7 million depending on the size of the practice. The AMA has not indicated a date of when ICD-10 should be mandated, but rather suggested HHS should call "on appropriate stakeholders, including physicians, hospitals and payors, to assess an appropriate replacement for ICD-9 within a reasonable timeframe," according to AMA CEO James Madara, MD.
However, not all healthcare groups have opposed the ICD-10 transition. The American Health Information Management Association, one of the main advocacy groups for HIM and the advancement of health information standards, urged the healthcare community to "keep moving on the ICD-10 transition" because a wait-and-see approach will force providers to inevitably miss the compliance date.
The American Hospital Association's Central Office also believes the transition to ICD-10 will be beneficial and will "allow for precise diagnosis and procedure codes, resulting in the improved capture of healthcare information and more accurate reimbursement." Although AHA said it recognizes there are several overlapping health IT initiatives, its members still support the adoption of ICD-10.
Paul Spencer, compliance officer for Fi-Med Management, says when he first became a certified coder in 1998, he was told ICD-10 would probably be coming by 2000. Now, ICD-10 will be coming 15 years after his certification. "The reason it was delayed was related to lobbying dollars to make sure it never saw the light of day," Mr. Spencer says. "Throwing lobbying dollars is not going to change this reality."
In the end, HHS and CMS have the final say. They have already delayed ICD-10 once. Previously, ICD-10 was supposed to go live on Oct. 1, 2011, but after earlier resistance, they pushed back ICD-10 to the current compliance date. CMS, in particular, has repeatedly said there will be no more delays and no grace period, even amidst the three-month postponement of Version 5010.
The ICD-10 compliance date is still more than 19 months away, which will give plenty of time for provider and HIM groups to draw more lines in the sand and pitch their cases for an ICD-10 delay. With a delay not imminent, though, hospitals, physicians and other healthcare providers may need to ask themselves: How will ICD-10 ultimately affect my productivity and bottom line, and is it worth waiting any longer?
Related Articles on ICD-10:
5 Areas of Risk in the ICD-10 Conversion
9 Things Healthcare Organizations Should Do Now to Prepare for ICD-10
AHIMA Launches ICD-10 Online Training Courses