ICD-10 Cost, Timing Concerns Explain AMA Vote

Cheryl Clark, for HealthLeaders Media , November 17, 2011

The AMA resolution itself predicts "a staggering increased work burden on physicians and their staff, with no direct benefit to patient care."

But Sue Bowman, director of coding policy and compliance for AHIMA, the American Health Information Management Association, said the delegates'  vote was "surprising and disappointing" to her and her colleagues. And she disagrees with Carmel's statement that ICD-10 won't benefit patient care.

That's because, she says, physicians and the entire healthcare industry can learn a lot from the much more precise data ICD-10 can reveal.

"One of the advantages of ICD-10 is better information on patient outcomes," Bowman says. "And that can be advantageous to physicians - not necessarily detrimental. For example, it might show that a procedure is more complicated and might have higher risks or be associated with more complications. Today, a lot of these simpler as well as more complex procedures are lumped into the same code.  It can help to support the physicians who are doing more complex procedures."

ICD-10's specificity, "can be used to support the medical necessity of a physician's service," which might be denied by a health plan under ICD-9 codes that are overly broad, and not explain why the service really was appropriate.

AHIMA, which has 63,000 members, include payers, hospital providers, vendors, government and health data agencies.

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6 comments on "ICD-10 Cost, Timing Concerns Explain AMA Vote"

RMartinez (2/12/2012 at 9:01 AM)
There are more facts to this than stated by those against the conversion. ICD-10 came out in 1993 and the US has been using ICD-10 mortality codes since around 1999. The current ICD-9 reflects our knowledge from the 1970's, when ICD-9 came out. Our ability as physicians to improve care is based on the quality of the data we have, so there is very good reason to install a more accurate system. Part of the push back and concern is that people are just now focusing on this and have concerns about cost. Understandable, but lets figure out how to improve the system and our practice for our patients. We are pretty good about getting things done when we put our shoulders together.

Diane Bristol (11/18/2011 at 11:35 AM)
Ms. Clark, I read your November 17, 2011, article on ICD-10 and it is clear that you're not in the trenches in a physician office. The estimated cost of implementation as well as lost productivity by the physician will lead to another access problem for patients. Learning an entirely new coding system and then finding the right code will be a costly, time-consuming project for both physicians and the billers/coders. I discussed ICD-10 implementation with my Congressman last spring. He indicated that Congress was led to believe that the USA was the last country in the world to adopt ICD-10. I provided him with MGMA information that no other country is using ICD-10 in the physician offices (with the exception of Germany) and other countries are only using a limited version of ICD-10 in their hospitals. For instance, MGMA provided information that Canada is using only 17,000 codes and Australia only 22,000 codes – and again, only in hospitals...not in physician practices. Canada and Australia took several years implementing ICD-10 one province/state at a time, and the governments of Canada and Australia paid for all expenses related to implementation. The cost of implementation of ICD-10 is estimated to be near $84,000 for my 3-physician office. Not only do we not have money available for this project, we have absolutely no way to recoup it if we borrowed it. Most patients are under some type of contracted payment – Medicare, Medicaid, BCBS, Managed Care plans, etc. Therefore, no matter what we charge for services, we only receive what the insurance company allows......the rest we write off. It amazes me that every other business in the country is allowed to increase their fees to recover increased costs except the field of medicine. ICD-10, in my opinion, is another unfunded mandate required by CMS with no real benefit to the patient. Diane Bristol MGMA member - Michigan

Steve Levine (11/17/2011 at 2:22 PM)
You left three key medical societies out of your list. We submitted a separate resolution that was also rolled into the one that passed. Please add the Texas, Nebraska, and North Carolina AMA delegations to your story. Thanks




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