AMA Executives Support Delay or Scrap ICD-10, Wait for ICD-11

Incoming president says problems are too big to move forward

Dr. Steve Stack takes over as President of the AMA in June of this year, and has an extensive background in HIT.

Dr. Steve Stack takes over as President of the AMA in June of this year, and has an extensive background in HIT.

Steven Stack, the incoming president of the American Medical Association (AMA), fully supports the delay of the implementation of ICD-10, now scheduled to begin October 1, 2015. In fact, in an interview with Healthcare Finance on Friday, May 15, he suggested that the industry should “just get to ICD-11 and get it done properly.” Stack went on to state, “We believe the problems associated with ICD-10 are so substantial, our policy is we should not move forward with ICD-10.”

Such a plan would delay a code system change for quite some time, since the initial draft of ICD-11 is not expected to be ready until 2017, according to the World Health Organization (WHO) website.

A plan to delay ICD-10 indefinitely is included in a congressional bill H.R. 2126, introduced on April 30 by Representative Ted Poe (R-TX), and is fully supported by the AMA in a letter sent to Representative Poe last week.

Rep. Diane Black's bill seeks to create an 18-month transition period with a moratorium of sorts for denials of "minor" errors

Rep. Diane Black’s bill seeks to create an 18-month transition period with a moratorium of sorts for denials of “minor” errors

Stack further suggested that if ICD-10 is implemented as planned, then there should be “a period in which providers should be held harmless.” This is the same concept suggested this past week in another bill, H.R. 2247, introduced May 12 by Representative Diane Black (R-TN), which calls for a transition period in which the Centers for Medicare and Medicaid (CMS) would prohibit denials for “minor” coding mistakes. The bill does not, however, call for a delay in implementation of ICD-10, but instead calls for CMS to accept dual coding of claims, using both ICD-9 and ICD-10 for a period of at least 18 months, with possible extensions, based on the effectiveness and productivity, to be measured and reported by CMS under the new coding system.

Get the PDF of the text of H.R. 2126 here.  Get the PDF of the text of H.R. 2247 here.

AMA CEO Offers to Work for Passage of H.R. 2126

The AMA's CEO made it abundantly clear in his letter of May 14 that he will put all the weight of the AMA behind H.R. 2126 to delay ICD-10 indefinitely.

The AMA’s CEO made it abundantly clear in his letter of May 14 that he will put all the weight of the AMA behind H.R. 2126 to delay ICD-10 indefinitely.

The Executive Vice President and CEO of the AMA, James Madara, sent the letter dated May 14 to Representative Poe to offer “strong support for the Cutting Costly Codes Act of 2015, H.R. 2126” which seeks to prevent the Secretary of Health and Human Services from replacing ICD-9 with ICD-10, as is scheduled. H.R. 2126 would also require the Secretary to conduct a study to identify steps that can be taken to mitigate the disruption ICD-10 would have on healthcare providers. The bill, however, in its current form, does not indicate how such a study would be conducted much less measured and evaluated.

Will the Bills Become Law?

Track the bill (but it's really not likely to pass) at govtrack.us

Track the bill at govtrack.us

Bills that are submitted to Congress are first assigned to one or more committees for evaluation and recommendation, before they may be brought to the chamber floor for debate and voting. The bill’s sponsor/s and party leaders garner support or opposition to the bill before any recommendation is sent to the Speaker of the House or the President of the Senate about the value of the bill. Websites like GovTrack.us and Congress.gov publicly post U.S. federal legislative information about such bills, track the progress of the bills, and provide a prognosis of a bill’s chance of becoming law.

Track this bill at govtrack.us

Track this bill at govtrack.us

As of this writing, GovTrack gives H.R. 2247 a 7% chance of moving forward, and only a 3% chance of being enacted; H.R. 2126 is given a 1% chance of being enacted.

Keep in mind that as H.R. 2, the bill to fix the SGR formula was being considered, GovTrack only gave it a 40% chance of being enacted, and within a few days was easily passed by the House and later by the Senate, both with overwhelming majorities. Evidently, there is, not surprisingly, considerable debate going on about these bills, outside what is publically available, making predictions of outcomes quite subjective.

Since the conversion to ICD-10 is not set to happen until October 1, however, there is a rather wide time-frame before the final switch is flipped, so to speak. Given the speed and relative ease with which the last delay of ICD-10 occurred in 2014, one wonders if there is any chance of something like that happening again.

What to Conclude?

All the options/possibilities seem to lead to the same situation...

All the options/possibilities seem to lead to the same situation…

Aside from the politics, the question remains, does either ICD-10 or ICD-11 actually contribute to improved care? Some physicians remain quite skeptical of any true value of all the statistics that ICD-10 and/or 11 will provide, and remember that only the U.S. uses these codes for determining payment. That in turn raises yet another question: if ICD-10 is such a problem, will ICD-11 be so much less of a problem? Also, if a large number of physicians (not sure what that means, really) are so resistant to ICD-10 coding, since there is no difference in their own reimbursements whether they include all that specificity or not, will ICD-11 offer any more “incentive” for those same physicians? And is that a large portion of the physician community or not?

long_wait

Waiting on ICD-10?

Despite those questions, and whether anyone can answer them or not, there’s no doubt that the final question is still, will ICD-10 be implemented in the U.S. or not?

For this reporter, there seems to be far too much invested now, by large systems and payors  ̶  who do have pretty significant clout with Congress, perhaps more than the AMA  ̶  to not go ahead with the October 1 implementation, even if it has some slight wrinkles, meant to ease physicians’ fears. In the meanwhile, there will be lots of noise and noise-makers.

Watch the calendar, stay on our email list, and our final word to the wise:  don’t hold your breath, either way.

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