The head of a trade group for medical records professionals said a presidential advisory committee is making the wrong recommendation regarding a cost-benefit study of using Snomed clinical terminology as a possible alternative to a proposed upgrade of the International Classification of Diseases code sets.
Not surprisingly, a Snomed official is saying it is wrong to suggest the government panel was wrong.
As reported in MP Stat April 16, the leaders of the 46,000-member Chicago-based American Health Information Management Association take issue with a key draft recommendation by the healthcare subcommittee of the President's Information Technology Advisory Committee issued earlier this month.
The 24-member PITAC, created in 1991 to advise the president on technology matters, is comprised of academic and private-sector IT leaders. It issued a list of draft recommendations for public comment, one of which was the Snomed Clinical Terms vs. ICD-10 cost-benefit study.
AHIMA Executive Vice President and CEO Linda Kloss, in a letter Wednesday to subcommittee co-chairman Jonathan Javitt, M.D., wrote to express "strong opposition to the PITAC subcommittee's April 13, 2004 draft recommendation to study the "cost-benefit" of upgrading the country's diagnosis and procedure code system from ICD-9-CM to ICD-10-CM and ICD-10-PCS.
"First, your recommendation wrongly implies that Snomed-CT can be an alternative for ICD-10-CM and ICD-10-PCS (referred to collectively as ICD-10). This is not a case of choosing one or the other. Even when SNOMED-CT, a reference terminology, is universally implemented, we will still need ICD. It is the classification system for grouping concepts in the terminology for a number of critical uses such as health and vital statistics trending, health policy and planning, reimbursement, and many administrative uses. So, we need both SNOMED and ICD-10."
In addition, Kloss wrote, "Your recommendation seems to ignore the extraordinary depth and rigor with which this issue has already been studied. The National Committee on Vital and Health Statistics recognized the need to replace ICD-9 over a decade ago.
"Since then, the (NCVHS) has developed the clinical modification to ICD-10 for use in the U.S., and the Department of Health and Human Services (DHHS) has developed ICD-10-PCS for coding procedures. And last fall, the NCVHS concluded its comprehensive evaluation of this issue by recommending that DHHS publish the Notice of Proposed Rule Making for implementation of ICD-10.
"NCVHS's decision was informed by a comprehensive and highly credible cost benefit study conducted by the Rand Corporation, and hundreds of hours of testimony by experts who examined all sides of the issue."
AHIMA suggested the subcommittee should recommend expedited implementation of ICD-10 as well as research into how to speed implementation of Snomed CT as well as "the value of mapping (it) to ICD-10."
A copy of Kloss's letter is available at ahima.org.
Kloss was unavailable for comment, but in a prepared statement released today she said, "The benefits of improved data from ICD-10 were quantified in the Rand Corporation's 2003 report to the National Committee on Vital and Health Statistics and shown to far outweigh the cost of implementing the updated classification system.
Rand estimated the cost of upgrading to ICD-10 at $425 million to $1.5 billion, but the Blue Cross and Blue Shield Association estimated it could cost as much as $14 billion.
Kent Spackman, M.D., chairman of the Snomed Editorial Board, said, "I would vigorously oppose their opposition to doing the study."
"You can't know, a priori, what the relative costs and benefits are unless you study it," he said.
Spackman, a professor of pathology and medical informatics at Oregon Health and Science University, Portland, said it's "perfectly reasonable not to delay" the conversion to ICD-10, but he doesn't agree that performing the cost-benefit study would require delaying the rollout of ICD-10 if need be.
Given the glacial pace of rulemaking and other red tape, to upgrade to ICD-10 "at the earliest now, we're probably talking 2007 or 2008," according to Dan Rode, AHIMA vice president of policy and government releations.
Spackman said he has read the executive summary of the Rand study and says the AHIMA reliance on it as dispositive of a cost-benefit study is simply wrong.
"It doesn't address the question of Snomed at all," Spackman said. "Yes, they did address the benefits . . . and came to the conclusion that it was worth the cost of moving from ICD-9 to ICD-10, assuming there were only two choices, moving or staying with ICD-9.
"I don't agree with the AHIMA conclusion that we should not study that alternative," he said. "I can see definite benefits to keeping billing codes separate from clinical codes and I can see drawbacks to it. We ought to look at those two alternatives and chose the right one."
Rode says talk of replacing ICD-9 with Snomed has come up before.
"They're not the same thing," Rode said."To suggest that Snomed could replace ICD-10, it would not take much of a study."