ICD-10 hearing: 'Pull the trigger, or pull the plug'

ICD-9 from a 'bygone era'
By Erin McCann
11:04 AM
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Capitol
One takeaway from the ICD-10 hearing on Capitol Hill this Wednesday? The majority of healthcare industry stakeholders called on federal lawmakers to issue no more delays for the code set implementation start date, which is set to take effect Oct. 1. There was, however, one voice of dissent, who wanted to see ICD-10 ditched once and for all.
 
Seven healthcare industry professionals, representing vendors, health insurance plans, physicians and health information management experts, testified before the House Energy and Commerce Committee's Subcommittee on Health regarding whether ICD-10 implementation should be delayed, kept on schedule or ditched all together. 
 
One of the witnesses, Richard Averill, director of public policy at health IT vendor 3M Health Information Systems, was part of the majority calling for no more delays in the coding set. 
 
 
When ICD-9 was developed back in the late '70s,"you could smoke in the patient's room," Averill said. "There was no personal computer, no internet and minimal invasive endovascular and laparoscopic procedures were not even envisioned. "ICD-9 reflects medicine of a bygone era."
 
For John Hughes, MD, a general internist and professor of medicine at Yale School of Medicine, ICD-10 proved crucial for improved specificity and accuracy of medical complications. "The ICD‐9 coding system fails to provide the level of detail needed to expand these efforts" of addressing medical complications, he said before the panel. 
 
Another "major flaw" in the ICD-9 coding set, as Hughes pointed, out: there's no ability to expand to describe "new treatments and technologies," things like minimally invasive surgery, for instance. With ICD-10, "you're able to identity specific actions, specific new procedures," he said. 
 
Not all witnesses agreed, however. William Jefferson Terry Sr., MD, spoke on behalf of the American Urological Association and small physician practices. All were struggling with the code set, he said, and would not be ready for ICD-10 now, or ever in fact. For Terry, the coding switchover represents a threat to docs and their business. 
 
The "potential benefits (of ICD10) are not documented," said Terry, and it's proven to be a costly mandate that "will certainly put some physicians out of business."
 
 
Terry, who advocated ditching ICD-10 altogether as opposed to another delay, explained his major concern is around the new coding set related to payments and the reality that a lot of physicians will lose payments for coding incorrectly. "Physicians have to have a guarantee that we're going to get paid if we don't code right," said Terry. "We provide a service, and you're not going to pay me if I code it wrong?"
 
Despite Terry being the only voice of opposition at the federal hearing Feb. 11, he has some big-time industry allies. 
 
Officials at the nation's largest association of physicians have also expressed fierce opposition to the ICD-10 transition. 
 
American Medical Association President Robert Wah, MD, in a recent speech addressing AMA board members and delegates, held nothing back. 
 
Wah, a self-described Star Wars fan, said, "Each of the six Star Wars films has this line: 'I have a bad feeling about this.' That's a common reaction to ICD-10. If it was a droid, ICD-10 would serve Darth Vader."
 
Forget delays, AMA wants ICD-10 gone altogether."For more than a decade, the AMA kept ICD-10 at bay – and we want to freeze it in carbonite!"
 
Cloud EHR vendor athenahealth also had a voice on Capitol Hill Wednesday in the company's Chief Financial and Administrative Officer Kristi Matus. 
 
Matus called on lawmakers to keep ICD-10 on track for the Oct. 1, 2015, start date or ditch it altogether, as "repeated delays in deadlines" further "undermine the government's credibility and impede progress on crucial initiatives. More delays will denote higher costs for providers and "provide cover for unprepared vendors." 
 
"Do not again kick this can down the road," she said. "Pull the trigger, or pull the plug."