AMA blasts ICD-10, while CMS relents on 5010
Looming ICD-10 deadline has AMA in open revolt
Seismic pressures building within the healthcare industry to improve quality, lower costs and rapidly adopt information technology have generated a pair of regulation-related temblors. One big shock came Nov. 14 when members of the American Medical Association’s House of Delegates voted to resist the federally mandated adoption of a new set of clinical codes. The delegates also called on the AMA to rally physicians against “its unnecessary and significant burdens on the practice of medicine.”
A CMS spokesman responded to the AMA in an e-mail, saying that providers have been given adequate time and flexibility to make the transition. “Implementation of this new coding system will mean better information to improve the quality of healthcare and more accurate payments to providers.” Three days later, though, the CMS announced it would ease off an enforcement deadline for the rollout of a related set of healthcare electronic data transmission standards, known as 5010.
Hospitals, office-based physicians, health plans and claims clearinghouses will have a 90day grace period before the CMS begins enforcing compliance with its rule to convert by Jan. 1, 2012, to the ASC X12 Version 5010 standards for electronic clams and other administrative communications. While relaxing enforcement, the CMS kept the compliance date the same. The CMS said “a majority of covered entities and their trading partners” would be unable to be in compliance with 5010 by Jan. 1, adding that it has “also received reports that many cov- ered entities are still awaiting software upgrades.” The switch to Version 5010 standards from Version 4010 is deemed to be a needed precondition to ICD-10 adoption.
The deadlines for both 5010 and ICD-10 transitions were set nearly three years ago. After initial postponements, the final rules for both, laying out the current deadlines, were issued in January 2009.
On the final day of their interim meeting in New Orleans, the AMA delegates passed a resolution from state medical associations in Alabama, Mississippi and Texas and two urology societies to “vigorously work to stop the implementation” of ICD-10 diagnostic and procedure codes. The resolution also called on the AMA to work with other informatics organizations to find “an appropriate replacement” for the ICD-9 codes now in use. The Cms-imposed deadline for ICD-10 adoption is Oct. 1, 2013.
At the New Orleans meeting, delegates passed several pro-it resolutions, including one supporting open competition in the development of electronic health information exchanges and another to provide practitioners with the ability to check on a patient’s healthcare benefits electronically in real time.
The American Hospital Association doesn’t back the AMA’S stand, according to Don May, AHA vice president for policy. “At this point we’re still supportive of ICD-10, but you can’t move forward without 5010, so we’ll have to see how that plays out.”
But it’s clear the AMA’S anti-icd-10 policy is tapping the zeitgeist with a growing number of increasingly anxious physicians. The Texas Medical Association, for example, has a “Calendar of Doom” on its website listing compliance deadlines, including one entry under the headline, “ICD-10 compliance. Make the transition or your claims won’t be paid.”
The Texas resolution called the ICD-10 conversion a “monumental change” that “will place a staggering increased work burden on physicians and their staff with no direct benefit to patient care.” The resolution noted that physicians “are already under much stress” from paperwork and “increased financial obligations” from the Patient Protection and Affordable Care Act.
Dr. Robert Wah, chairman of the AMA’S board of trustees and chief medical officer of IT services provider Computer Sciences Corp., said the association resolution opposing ICD-10 shouldn’t be viewed in isolation.
“The statement is indicative of the level of frustration with the regulatory and financial pressures on physician practices across the country,” Wah said.
Wah conceded there could be public health benefits from gathering more complex and granular data via ICD-10, but from the delegates’ perspective, “This was just one more thing where we don’t see how it’s going to improve individual patients’ care.”
And it’s not just physicians feeling overburdened, Wah said. “I think a lot of people are starting to blink here a little bit.” California’s Medicaid program, for example, has announced it won’t be in timely compliance with the 5010 rule, he said. “The states are feeling the same pressure.”
ICD-9, released by the World Health Organization in 1975, was adopted by the U.S. in 1979. ICD-10, out in 1990, is used around the globe, but in the U.S., ICD-9 still dominates.
An initial release of ICD-11 is expected in 2015, and that should be the focus of U.S. attention now, according physician informaticist Dr. Joseph Schneider, chairman of the Texas Medical Association’s health IT committee and chief medical information officer for Baylor Health Care System in Dallas.
“There is a general consensus that ICD-9 is
The AMA House of Delegates voted in New Orleans to oppose the ICD-10 deadline.