AMA's ICD-10 letter suggests a new political strategy

The American Medical Association recently sent a letter to House Speaker John Boehner, asking Congress to stop the implementation of the ICD-10 diagnostic code set. The letter, from AMA Executive Vice President and CEO James Madara, expressed the will of the AMA House of Delegates, which passed a resolution with similar language last November. Yet the timing of this letter to the leader of the Republican majority in Congress is still curious, coming as it does at the onset of a Presidential election year.

When the House of Delegates adopted its resolution, AMA leaders knew that it was an "aspirational statement," the words of AMA board chair Robert Wah. Nevertheless, Wah told InformationWeek Healthcare that he hoped the Administration would work with the AMA to delay ICD-10 implementation. The Obama Administration stated that it would continue to move forward with ICD-10. Yet the letter to Boehner suggests that the AMA leadership still has some hope of killing the project.

The AMA's arguments, in a nutshell, are these: implementing ICD-10 will be costly and burdensome for physician practices; the transition to ICD-10 could temporarily threaten their cash flow; physicians must invest in health IT, including ICD-10, while Medicare rates are falling; and they also must face penalties for non-compliance with the e-prescribing, Meaningful Use, and PRQS programs. Most of these arguments have been made before, but the mere fact that the AMA is now applying to the Republicans for relief suggests it has a new strategy.

First, the argument that government regulations are hampering small businesses (in this case, physician practices) is one that Republican presidential aspirants have been making on the campaign trail, and that the eventual candidate undoubtedly will use in debating President Obama. So the AMA letter could serve as a small but sturdy prop bolstering the Republican position.

Second, if the GOP retakes the White House in 2012, the Republicans will seek not only to overturn healthcare reform, but also to reverse many other Obama regulations. Of course, the HIPAA legislation authorizing ICD-10 goes back much further than this administration, and the U.S. Department of Health & Human Services is enforcing a deadline set during the Bush years. But the current ICD-10 start date of Oct. 1, 2013--which itself represents a two-year delay from the original deadline--will fall after the next president takes office. If he happens to be a Republican, the AMA could--and probably will--argue that the next administration should lift this onerous burden from the doctors who care for Medicare patients.

There are two problems, however, with this putative argument: First, many physicians and hospitals already have invested substantial amounts into ICD-10, and will accelerate their efforts to meet the current deadline. So to stop that train dead in its tracks in January 2013 would waste an enormous amount of resources.

Second, despite the challenge that ICD-10 represents to physicians, it would be foolish to suppose we can stick with the status quo. In November, M. Christine Kalish, executive consultant at the Beacon Partners consulting firm, wrote in a blog post that the AMA position on ICD-10 was shortsighted and that physicians should recognize that the benefits of ICD-10 far outweigh the costs. The ICD-9 code set, she noted, is outdated and can no longer support the addition of codes for new diagnoses. Having more specific codes, she argued, will reduce claims processing costs--and, presumably speed payments--because health plans will make fewer requests for more information. The greater specificity of ICD-10 also can support quality improvement and outcomes analysis in ways that ICD-9 is not capable.

While the AMA's arguments certainly carry weight--especially at a time when many practices are adapting to EHRs--it's a fantasy to think that the U.S. can retain the old diagnosis codes indefinitely while the rest of the world has moved onto ICD-10 and will soon take up ICD-11. Perhaps the U.S. healthcare industry won't be ready to make the leap by Oct. 1, 2013, and the deadline will have to be postponed further, but until fee for service goes away and EHRs become universal--neither of which will happen anytime soon--we will need a better coding system. - Ken

Editor's note: FierceHealthIT is hosting a breakfast panel discussion on ICD-10 preparedness on Feb. 22 at the HIMSS conference in Las Vegas. Executives from leading healthcare organizations will share what they're doing now to ensure a smooth--and even profitable--transition to ICD-10. For more information and to register, visit the ICD-10 Readiness for Hospital IT Leaders: Lessons Learned from the Trenches website.