Lawmakers' bills keep spotlight on ICD-10 debate

Sen. Tom Coburn (R-Okla.) has introduced a Senate version of the Cutting Costly Codes Act of 2013, a bill aimed at blocking HHS from implementing the ICD-10 diagnostic and procedural codes, which it is scheduled to do on Oct. 1, 2014.

Given the Obama administration's support for ICD-10, the chances that the bill will kill implementation efforts once and for all appear unlikely. But what it will most certainly do is keep alive the healthcare industry's debate on ICD-10 implementation.

Coburn, a physician, has lined up three co-sponsors in the Senate including optometrist John Boozman (R-Ark.) and two of his fellow doctors: John Barrasso (R-Wyo.) and Rand Paul (R-Ky.). The same bill was introduced in the House of Representatives last month by Rep. Ted Poe (R-Texas).

In a white paper he published last year, Coburn wrote that while “the compliance costs of ICD-10 are tangible, the benefits are much more esoteric.” And, in an e-mailed news release, Coburn said that HHS should stop ICD-10 implementation while “healthcare providers struggle to navigate the murky waters of healthcare reform.”

But Deborah Green, chief operating officer of the American Health Information Management Association, said ICD-10 implementation is essential for healthcare reform to move forward and described it as the “linchpin” necessary for the success of initiatives such as meaningful use of health information technology, value-based purchasing and quality improvement efforts.

“We want to monitor the bill and see what evolves,” Green said, calling the measure a “potential negative signal” issued just 18 months prior to ICD-10's scheduled implementation.

In his release, Coburn cited a 2008 report funded by the American Medical Association, MGMA-ACMPE and others, that concluded that the cost of implementing ICD-10 could be as high as $83,000 for a three-physician practice and as much as $2.7 million for a large practice with 100 doctors.

Robert Tennant, a senior policy adviser for the MGMA, said the 2008 study has not been updated, but he added that it's unlikely that the cost of implementation has gone down. Tennant also said that his organization will be conducting a survey on ICD-10 readiness within the next two months.

Citing a recent study by the Workgroup for Electronic Data Interchange, or WEDI, Tennant said it remains unclear if the industry will be ready by the Oct. 1, 2014 implementation date set by HHS. While not taking a position on the bill, Tennant said medical practices have to be concerned that their trading partners—such as electronic health-record vendors and health plans—will be ready in time.

“It does not bode well for a smooth glide path for compliance,” he said.

While advocates of ICD-10 often point out how the U.S. is one of the last wealthy countries to adopt ICD-10, Tennant noted that Canada took five years starting in 2001 to transition to the new codes and then did so only on the hospital side—not on the physician-office side. He added, too, that “the government paid for everything.”

Tennant also pointed out that other countries have implemented much smaller code sets. For example, he said, Germany's version of ICD-10 has only around 13,300 codes, while the U.S. version is expected to start with 68,000. Germany switched to its version of the codes in 2000.

That's an argument that AHIMA's Green said is irrelevant.

“No other country uses ICD for as many purposes as we do, and the U.S. uses ICD the most extensively for reimbursement purposes,” she said. “Just as the number of words in a dictionary doesn't make the dictionary harder to use, a higher number of codes doesn't make the coding system harder. In fact, it can actually make the system easier and more valuable because it reduces ambiguity.”

Green added that she believes that HHS is “absolutely committed” to the Oct. 1, 2014 implementation date and said that the agency has asked AHIMA to help it with physician outreach efforts.

Tennant also said that, no matter how practices feel about ICD-10, they have to prepare for its implementation.

“We're trying to get our members ready—it's a lot of education,” he said. “If you just delay for a year without taking any steps, you'll be in the same boat you were before—only you'll be there a year later.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks