MGMA urges changes in ICD-10 implementation approach

The Medical Group Management Association (MGMA) has requested, in a letter sent to U.S. Department of Health & Human Services Secretary Kathleen Sebelius, that HHS change its approach to implementation of the ICD-10 diagnostic set and, if possible, limit the required adoption of ICD-10 to hospitals.

HHS recently announced it would postpone the deadline for using ICD-10 from Oct. 1, 2013, to an as-yet-undetermined date. MGMA, the American Medical Association, and other physician societies were jubilant, but many hospitals that had invested heavily in ICD-10 were disappointed. Last week, the College of Healthcare Information Management Executives (CHIME) urged HHS "to move quickly and decisively in setting a new compliance date for converting to ICD-10."

MGMA has long questioned the rationale for ICD-10 and has expressed reservations about HHS' implementation strategy. In its letter, MGMA asks HHS to take several steps before requiring the use of ICD-10 in claims and other administrative transactions, including:

  • Conducting a cost-benefit analysis to determine how each sector of the healthcare industry will be impacted by a change to ICD-10.
  • Pilot-testing ICD-10 in practices of different sizes, small and large hospitals, providers using paper and electronic records, and safety net providers. The pilots should be fully funded by HHS.
  • Analyzing the impact of ICD-10 on overlapping physician mandates such as Meaningful Use, e-prescribing and quality reporting.
  • Assessing the changes necessary to improve the ICD-9 code set so that new codes can be added to it as an alternative to ICD-10.
  • Considering implementing ICD-10 only in hospitals, as has been done in Germany, Canada and Australia.
  • Staggering ICD-10 implementation dates, allowing providers to comply at least 12 months after health plans and clearinghouses do.
  • Requiring ICD-10 certification for health plans and clearinghouses, as well as for practice management and billing system software.

Robert Tennant, senior policy advisor to MGMA, told FierceHealthIT that there were two reasons for the letter. First, with HHS reexamining ICD-10, the trade association wanted "to put a stake in the ground and say that if we're going to move forward, it has to be done in the right way."

Since Germany and some other countries have decided not to apply ICD-10 to ambulatory-care providers, he said, "maybe we should take another look" at whether that should be done in the U.S.

Second, Tennant noted, "we're right in the middle of [the transition to the] 5010 [transaction set], which hasn't gone well." MGMA members have complained about cash flow disruptions, he noted, and the same thing happened during the transitions to the 4010 transaction set and the National Provider Identifier.

"We should figure out if there's a better approach to moving the industry," he said.

To learn more:
- read the MGMA letter to HHS


Driving Engagement in an Evolving Healthcare Ecosystem

Deep-dive into evolving consumer expectations in healthcare today and how leading providers are shaping their infrastructure to connect with patients through virtual care.

Suggested Articles

UPMC Health Plan is expanding its medication adherence program with Sempre Health to include diabetes medications.

Despite efforts to improve patient safety over the past 20 years, results have not been optimal. We raise vital questions and renewed areas of focus.

The Trump administration has enlisted CVS Health to pilot administering the therapy to patients in long-term care facilities and at home.