TECH­NOL­OGY:

AMA blasts ICD-10, while CMS re­lents on 5010

Modern Healthcare - - NEWS - Joseph Conn

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.

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