For­get the up­grade

Texas the most stri­dent of ICD-10 man­date foes

Modern Healthcare - - THE WEEK IN HEALTHCARE - Joseph Conn

In Texas, “ICD-10” and “com­pli­ance dead­line” are be­com­ing fight­ing words. The Texas Med­i­cal As­so­ci­a­tion wants the fed­eral gov­ern­ment to not only back off from its man­date that the health­care in­dus­try up­grade to the ICD-10 di­ag­nos­tic and pro­ce­dural codes by Oct. 1, 2014, but to drop the ICD-10 up­grade idea al­to­gether.

In a let­ter to HHS Sec­re­tary Kath­leen Se­be­lius, Dr. C. Bruce Malone, the Texas as­so­ci­a­tion pres­i­dent, said the con­ver­sion “will in­tro­duce great cost ... with­out a cor­re­spond­ing ben­e­fit.” In­stead, Malone said, it would be bet­ter to ei­ther wait for the re­lease of ICD-11, ex­pected in 2015, or switch to adopt­ing the Sys­tem­atized Nomen­cla­ture of Medicine-Clin­i­cal Terms, or Snomed CT, with “an ap­pro­pri­ate trans­la­tor pro­gram.”

Malone’s let­ter was one—and ar­guably the most stri­dent—of sev­eral sub­mit­ted to the gov­ern­ment last week as the com­ment pe­riod for a pro­posed rule-shift­ing ICD-10 com­pli­ance from Oct, 1, 2013, to Oct. 1, 2014, closed.

Dr. Joseph Sch­nei­der, vice pres­i­dent and chief med­i­cal in­for­ma­tion of­fi­cer at Bay­lor Health Care Sys­tem, said if physi­cians must learn a new cod­ing lan­guage, let it be a clin­i­cal lan­guage such as Snomed “that they would use for­ever and ever” and then cross-ref­er­ence it to what­ever ver­sion of ICD is cur­rent. “Then, be­hind the scenes, where all the trans­lat­ing and billing is done, first by hu­man be­ings and later by ma­chines, you can change it to ICD-13 or 14 or 15, as long as we keep our lan­guage the same,” said Sch­nei­der, who chaired the TMA’S health in­for­ma­tion tech­nol­ogy com­mit­tee.

Sch­nei­der said he fa­vors na­tion­wide adop­tion of Con­ver­gent Med­i­cal Ter­mi­nol­ogy, a doc­u­men­ta­tion lan­guage de­vel­oped by Kaiser Per­ma­nente and do­nated to the Na­tional Li­brary of Medicine. It not only pro­vides cross-map­ping be­tween Snomed and ICD-9 and ICD-10, but it also con­verts terms on a physi­cian’s prob­lem list from a clin­i­cal lan­guage fa­mil­iar to them to lay-

The ICD-1O con­ver­sion “will in­tro­duce great cost ... with­out a cor­re­spond­ing ben­e­fit.”

—Dr. C. Bruce Malone, Texas Med­i­cal As­so­ci­a­tion pres­i­dent

man’s lan­guage. That can be shipped to a pa­tient’s per­sonal health record and bet­ter un­der­stood by peo­ple with­out med­i­cal train­ing.

Texas was one of sev­eral states that pushed the Amer­i­can Med­i­cal As­so­ci­a­tion’s House of Del­e­gates last fall to adopt an anti-icd-10 pol­icy. AMA Ex­ec­u­tive Vice Pres­i­dent Dr. James Madara wrote to CMS Act­ing Ad­min­is­tra­tor Marilyn Taven­ner this month ask­ing for an ad­di­tional year’s de­lay for ICD-10 to Oct. 1, 2015. He added that if “stake­hold­ers can­not reach con­sen­sus on this mat­ter dur­ing this two-year pe­riod, then the move to ICD10 should be post­poned in­def­i­nitely.”

The MGMA-ACMPE in its com­ments last week called for pi­lot test­ing of ICD-10 be­fore set­ting a com­pli­ance dead­line and then stag­ger­ing im­ple­men­ta­tion dates, re­quir­ing health plans and claims clear­ing­houses to be ready one year ahead of providers. The MGMA also said the CMS should “sig­nif­i­cantly aug­ment ed­u­ca­tion and out­reach to providers—es­pe­cially small and ru­ral providers and those treat­ing un­der­served pop­u­la­tions.”

“What we’re ask­ing for is a re­ally com­pre­hen­sive look at this, and af­ter you’ve looked at it, make a decision if it’s the best for the in­dus­try,” Robert Ten­nant, se­nior pol­icy ad­viser for the MGMA, said in an in­ter­view.

The Amer­i­can Health In­for­ma­tion Man­age­ment As­so­ci­a­tion, which has ad­vo­cated ICD10 adop­tion for more than a decade, op­poses ex­tended de­lays. In a Mod­ern­health­ com­men­tary, AHIMA CEO Lynne Thomas Gor­don urged HHS not to ex­tend the de­lay be­yond one year so that ICD-10 will be im­ple­mented by Oct. 1, 2014.

The U.S. “has had 18 years to pre­pare,” since the World Health Or­ga­ni­za­tion mem­ber states be­gan us­ing ICD-10 in 1994. The CMS set an Oct. 1, 2013 com­pli­ance dead­line in Jan­uary 2009 and has pro­posed one more year to get com­pli­ant, she said.

The Fed­er­a­tion of Amer­i­can Hos­pi­tals is call­ing the pro­posed de­lay “ap­pro­pri­ate,” not­ing FAH mem­bers “have in­vested sig­nif­i­cant re­sources in train­ing their staff to meet Oct. 1, 2013 readi­ness,” FAH Pres­i­dent and CEO Chip Kahn said in a let­ter to Taven­ner.

Oth­ers, Kahn said, be­lieve a two-year de­lay “of­fers stronger safe­guard” against claims dis­rup­tions. FAH mem­bers are wary, based on their ex­pe­ri­ence with the im­ple­men­ta­tion of the ASC X12 Ver­sion 5010 stan­dards for the elec­tronic trans­mis­sion of claims, which got off to a rocky start Jan. 1, 2012. FAH hos­pi­tals were ready for 5010, Kahn said, but “other seg­ments of the in­dus­try” were not, he said.

In its let­ter, the Amer­i­can Hospi­tal As­so­ci­a­tion re­peated its back­ing of a post­pone­ment while fa­vor­ing the even­tual ICD-10 roll­out.

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