Health IT – ICD-10 Battle Is Taking the Form of a World Heavyweight Title Fight

The battle between the health IT industry and provider associations over ICD-10 adoption is imminent.

Imagine the MGM Grand Arena in Las Vegas filled to capacity with enthusiastic fans awaiting the start of an epic boxing match. A heavyweight title fight that will sure to go down in the history books as one of the best fights of all time. Of course, a main event of this magnitude must begin with the distinct voice of legendary ring announcer Michael Buffer’s claim-to-fame cadence – Let’s Get Ready to Rumble!

Let’s meet the contestants:

In one corner stand the provider organizations with the American Medical Association (AMA), for the moment, taking the lead role in the battle. But take note that the American Hospital Association (AHA) and the Medical Group Management Association (MGMA) both share similar views but have yet to officially enter into the battle. The common ground shared by all provider organizations is that physician practices and providers will ultimately be the ones incurring the cost and owning the responsibility of implementing ICD-10. The key issue the AMA has voiced is that ICD-10 implementation offers no direct benefit to patient’s care and that the conversion will create a significant burden on the practice of medicine.

In the other corner is the health IT industry organizations with the American Health Information Management Association (AHIMA) taking the lead role in the battle. The AHIMA’s position is that all healthcare providers need to stay the course in order to meet the ICD 10 implementation deadline of October 1, 2013. It does appear that perhaps the Academy of Professional Coders (AAPC) may join the AHIMA in the fight in the very near future. The AHIMA’s position is urging all healthcare providers to stay the course with ICD 10 transition related activities.

The battle between industry and providers over ICD-10 is being fought between those who stand to profit in the near-term and those who represent the providers that will have to finance and implement ICD-10. And while the battle is currently being fought by the association generals, there are a host of tech vendors, coding service providers, foot soldiers, if you will, who will inevitability join the fight as well.

It’s very early in this fight and it appears that the AMA maybe winning the early rounds. The Centers for Medicare and Medicaid (CMS) Administrator Marilyn Tavenner, in response to the advocacy efforts of the AMA, announced that the agency would take another look at the timeline for converting from the ICD-9 billing code set to ICD-10.

Aside from the cost associated with the transition and the impact to provider organizations, is there a downside to a delay in ICD-10 implementation?

Current speculation is that CMS may push the deadline for ICD-10 implementation back one year. If this becomes the case, this means that the U.S. healthcare system can’t complete all aspects of healthcare reform. Information the government needs to collect to provide effective clinical research on what treatments work and which ones are less effective is tied to the more specific information gathered by the use of ICD-10 codes. Those that are advocating for an implementation delay clearly don’t understand the benefits of the more detailed coding ICD-10 will bring. For example, one of the changes in ICD-10 is to better track follow-up care. It is important to healthcare funders and the public to know what specific follow-up care is being given for a particular event or illness. This one outcome of ICD-10 implementation will promote better patient care and outcomes.

Another downside to delaying ICD-10 implementation is that healthcare organizations cannot effectively complete strategic planning if rules like this keep changing. Any significant delay to the current ICD-10 implementation deadline could raise the implementation cost to medical practices.

One other key downside to delaying implementation is the fact that the United States is already a decade behind the rest of the world in using the most up-to-date International Disease Classification System – ICD-10. Can the United States continue to remain behind the rest of the world knowing that the ICD-11 beta is projected for the 2014-2015 timeframe?

Whether the government moves to delay ICD-10 implementation or not, this is the time for medical practices to review their health IT systems and infrastructure in order to develop a strategy that will optimize those systems to make the transition to ICD-10 easier. ICD-10 is a critical component to the many other healthcare initiatives currently underway to transition the country’s healthcare system to the twenty-first century. There’s really no point in moving forward with the other healthcare reform initiatives if the data that is being pushed out remains in ICD-9 format.