Congress is still debating whether ICD-10 should be implemented this fall or not.   One of the main reasons is the possible explosive costs to practitioners including hospitals and small practices which some have estimated to be as high as a quarter of a million for small practices to implement.   Besides Obamacare also having to be institutionalized, it is probable that the costs for small practices, and even bigger ones including hospitals, could be numbing at the least.

ICD-10 Debated on Capitol Hill;

Most in Favor of 2015 Implementation

Feb 23, 2015

The House of Representatives’ Energy and Commerce Committee’s Subcommittee on Health held a hearing on the transition to ICD-10 this week that ended up being lopsided in favor of moving forward with the transition.

The panel included stakeholders from the healthcare industry, including practitioners, advocacy groups, and vendors. Most members of the panel were in support of keeping Oct. 1, 2015 as the official deadline for ICD-10 implementation. Only one, William Jefferson Terry, M.D. from the Mobile, Ala. Urology Group, represented an anti-ICD-10 voice. Although a few doctors in Congress, most prominently, Rep. Larry Buschon, M.D. (R-Ind), spoke out against the ICD-10 transition.

Some medical groups, such as the Medical Group Management Association (MGMA) and the American Medical Association, are pushing for a third delay of the compliance deadline for the code-set. Neither group had official representatives on the panel, although Dr. Terry has been associated with the AMA in the past. He was speaking on behalf of the American Urological Association at the hearing.

The debate centered on the cost and benefits of the ICD-10 transition. John Hughes, M.D. Professor of Medicine at the Yale School of Medicine, said that ICD-10 will accurately describe information on procedures that will ultimately lead to new discoveries and treatments. Sue Bowman, the senior director of coding policy and compliance for the American Health Information Management Association (AHIMA), listed the many improvements that will come from ICD-10 including analysis, ability to measure outcomes, public health measures, and much more.

Cost became a hot topic. Those like Dr. Terry said the transition to ICD-10 was costing physicians. Many, he said, were opting to retire early than face ICD-10. He recommended an implementation that should be carried out over 2-3 years. Buschon said that in his own life, the administrative costs of ICD-10 led to his practice being sold to a hospital.

Having cited a study that said the cost of transition would be up to $250,000 for small practices, some disputed his claim it would be this overwhelming. Rich Averill, director of public policy at 3M Health Information Systems, said that another study had shown the cost for small practices to on average about $8,000.

Many derided the ICD-9 code-set as out of date. Bowman said it doesn’t fit with a 21st century health system. Averill noted that when ICD-9 was implemented, you could still smoke in a room with the patient. “The reality is with ICD-9 we often don’t know what really is wrong with the patient or what procedures were performed. ICD-9 codes like a repair of an unspecified artery by an unspecified technique are virtually useless for establishing fair payment levels or evaluating outcomes,” he said.

Hughes at Yale Medicine testified on his own frustrations with using ICD-9. “I have been frustrated many times at ICD-0’s inability to specify the exact nature of a complication, its extent, its location, and how it was treated,” he said. He said it doesn’t have the capacity to describe new technologies. Also speaking in favor of the transition was Kristi Matus, chief financial and administrative officer of Watertown, Mass.-based vendor athenahealth, Edwin Burke, M.D. a practicing physician, and Carmella Bocchino, of the America’s Health Insurance Plans (AHIP) group.

Carmella Bocchino

  • Executive Vice President of Clinical Affairs and Strategic Planning

– See more at: http://energycommerce.house.gov/hearing/examining-icd-10-implementation#sthash.JdlrH0My.dpuf

Carmella Bocchino

  • Executive Vice President of Clinical Affairs and Strategic Planning

– See more at: http://energycommerce.house.gov/hearing/examining-icd-10-implementation#sthash.JdlrH0My.dpuf

On the specificity of the code-set, Terry said that the ICD-10 was too granular. He noted that there were more than 200 codes for diabetes alone. He said this increased granularity would lead to reduced production from physicians. He said the codes were statistics and not for people who want to practice.

After initial testimony, Rep. Joe Pitts (R-PA) took a vote asking panelists if the health industry was ready to implement ICD-10. Everyone, except Terry, said yes. When he asked if another delay should be opposed, everyone again said yes except Terry

About Definity Healthcare Administrative Services

My knowledge and experience includes working in the healthcare and computer fields for many years and my educational background includes a Ph.D. in Higher Education, Master’s in Public Administration, Bachelors in Psychology, over 80 credit hours from Pima Community college in healthcare administration and computer technology and another 30 credits from Tacoma Community College where I earned my Associates in Health Information Management and my RHIT certification. All of this education and experience has enabled me to earn four national certifications (CCS and CCS-P from AHIMA and CPC-H and CPC from AAPC) and to write two medical coding books for Cengage/Delmar Publishers. I have worked for more than 25 years with all types of schools, businesses, and agencies and have learned well what creates and what destroys quality. I have used my vast knowledge and education to problem solve including creating tremendous successes out of long-term failures. While others may strive to make lemonade out of lemons, at Definity Healthcareour standards of quality are higher as we make the finest lemon meringue pies instead!
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