Contributed by Diane Dannenfeldt

WASHINGTON – The new year likely will be beset by controversy surrounding the cost and value of plans to implement new clinical classification codes, with several of the nation’s largest healthcare organizations squaring off with opposing views.
Provisions in the recently passed Medicare reform act could establish a way to arbitrate the differences. The Act creates a commission charged with prioritizing and developing a timeline for the implementation and adoption of IT standards in the healthcare industry, among them the clinical codes.
“We believe it’s the right time to lay out a road map over the few years to provide some order, some predictability and some awareness of what the industry can accomplish over what period of time,” says Theresa Doyle, director of policy for the Blue Cross and Blue Shield Association.
The national Blues organization has been one of the primary opponents to industry wide adoption of the International Classification of Diseases, 10th edition, called ICD-10.
The National Committee on Vital and Health Statistics, charged with setting standards to help automate the healthcare industry, has recommended that the ICD-10 diagnostic and procedural codes replace current ICD-9 codes as clinical standards under the transactions and code sets rule of the Health Insurance Portability and Accountability Act.
An NCVHS-commissioned study by the Rand Corp. indicates the switch in coding standards could cost hospitals $425 million to $1.5 billion to implement, but would provide benefits of $700 million to $7 billion. The American Medical Association and the American Health Information Management Association have urged adoption of the standards, citing a study showing that the ICD-10 codes offer clearer clinical descriptions. And both the American Hospital Association and the Federation of American Hospitals have pushed for quick adoption of the ICD-10 codes.
The national Blues organization, however, has questioned the estimated costs and benefits, arguing for a more cautious approach. The association released a report late last year estimating that the move to ICD-10 codes could cost as much as $14 billion over two to three years.
“We don’t feel enough is known about the ramifications of the coding change on reimbursement alone,” the Blues’ Doyle says. “Large academic medical centers may do better, and rural and community hospitals may do worse, but the point is that there’s uncertainty. No one really knows.”
Doyle also argues that complicated conversions to ICD-10 codes must be put behind other mandated IT projects that are now on healthcare organizations’ plates.
“Beyond this, we have three additional regulations for the initial HIPAA standards, plus the e-prescribing standards that were just approved with Medicare reform. When you lay it all out, you realize the industry has a great deal of IT work before it over the next several years.”
But there are costs involved no matter what direction is taken on the controversy, contends Jeffrey Blair, vice chair of the subcommittee on standards and security of the National Committee on Vital and Health Statistics.
“No one has done a study that indicates what is the cost of not doing anything. It’s hard to measure these things becomes some of the benefits and impacts are on quality of care, patient safety and medical research,” he said. “Boiling those down to a dollar figure is not straightforward.”
Any conversion to the new clinical code set is years away, Blair said.
“Typically it takes at least a year for there to be issued a notice of proposed rule making, and then comments are reviewed, which generally seems to take at least a year,” he said. “If HHS decides to make the transition, the compliance date would probably be four to six years away.”
The Healthcare Information and Management Systems Society is taking a middle-of-the-road approach to the ICD-10 issue.
“Our workgroup is looking at all sides of the issue and trying to find valid reasons for the conversion,” says Dave Roberts, director of public policy for HIMSS. “But based on the Medicare reform legislation, I think the timeframe for an ICD-10 mandate has been pushed back. I’m not sure we’ll even see final regulations this year.”