Forget the upgrade
Texas the most strident of ICD-10 mandate foes
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 Modernhealthcare.com 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.