A look inside AMA lobbyists' role in the ICD-10 delay

By Alex Bronstein-Moffly
08:40 AM
a:2:{s:5:"title";s:61:"Alex Bronstein-Moffly, analyst at First Street Research Group";s:3:"alt";s:0:"";}

Among healthcare industry bodies that lobby, the American Medical Association (AMA) has few equals. Look no further than the new ICD-10 compliance date for evidence bearing out that assertion.

The AMA outspends AHIMA and other major ICD-10 players on lobbying efforts, by a rather wide margin, and calling on House Speaker John Boehner likely helped its cause, but the real ace up its sleeve just might be several key relationships in the right places of Congress.

Now that the association eked out a year’s delay, the second phase of its lobbying strategy – calling on Congress to legislatively rule out the ICD-10 conversion altogether – remains.

Will the AMA hold its fire? Or will the group continue its crusade to stop ICD-10 entirely?

Big money
In 2011, the AMA’s lobbying shop spent $20.9 million, hired five outside lobbying firms and was represented by 66 lobbyists. Lobbying was not AMA’s only advocacy tool; the group also has a powerful Political Action Committee that has contributed over $250,000, including contributions to 59 current members of Congress, since 2011. The group’s resources and status as a premier healthcare lobbying association has helped it build the relationships with government that are vital to such lobbying efforts.

[Q&A: ICD-10 delay a 'pragmatic compromise without changing the principles'.]

The ICD-10 battle centers on swaying the opinion of Congress or the Department of Health and Human Services (HHS), which controls ICD-10 implementation regulations. AMA’s initial public steps in their campaign included sending two letters to government officials.

In the first letter, sent to Speaker Boehner, the AMA asked the Speaker to stop implementation of ICD-10, via legislation, as the Speaker does not have jurisdiction over ICD-10 implementation. In the second letter, sent to Secretary Sebelius, the AMA asked her to halt ICD-10 implementation altogether. The letters cited health IT regulations that are currently being implemented as well as the President’s recent executive order for federal agencies to reassess and streamline regulations, as reasons to halt ICD-10 implementation.

On February 16, 2012, Secretary Sebelius announced that HHS would be delaying implementation of ICD-10, which had been slated to take effect on October 1, 2013. Following that, on April 9, 2012, the Secretary announced that ICD-10 implementation would officially be delayed for one year until October 1, 2014.

The AMA responded favorably, saying its members and “physicians across the nation appreciate that CMS has proposed delaying the ICD-10 implementation date” – but the association gave no indication that its lobbying against ICD-10 was over.

Two-pronged approach
This victory for the AMA demonstrated the strength of its lobbying operation. The decision signaled that while HHS was willing to listen to the concerns of advocacy groups like AMA, they are not yet ready to discuss halting implementation completely.

To get this important first victory and chart its course ahead, the AMA took a two-pronged approach, with Congress and its ability to repeal the law being one focus, and HHS and its ability to delay/tweak implementation being the other.

[Related: 3 pieces of the ICD-10 conversion to outsource -- and the 1 you cannot.]

The letter to Speaker Boehner represented AMA flexing its relationships. The organization currently employs seven in-house lobbyists that have worked in Congress, for eleven different Members, including five that worked specifically on Health Issues. By calling Congress’s attention to this issue at a time when regulation was considered a dirty word, the AMA was betting that Congress would be willing to listen.

With the AMA’s connections to Congress, the group would have no trouble targeting and reaching their audience. Current AMA lobbyists that worked in Congress include:
• Lindsey Brill
   o Legislative Assistant (Health Issues) - Lincoln D. Chafee (I)
   o Legislative Assistant (Health Issues) - Rep. Walter B. Jones (R-NC)
• Dana Lichtenberg
   o Legislative Director (Health Issues) - Rep. Bart Gordon (D-TN)
   o Legislative Assistant (Health Issues) - Rep. Eddie Bernice Johnson (D-TX)
   o Scheduler; Executive Assistant - Rep. Brad Sherman (D-CA)
   o Legislative Correspondent - Rep. Vic Fazio (D-CA)
• Jason Marino
   o Legislative Assistant (Health Issues) - Sen. Robert C. Byrd (D-WV)
• Thomas Cordrey Roberge
   o Legislative Counsel - Sen. Peter G. Fitzgerald (R-IL)
• Jennifer Lee Shevchek Meeks
   o Legislative Aide (Health Issues) - Former Sen. Arlen Specter (R/D-PA)
• Cybil Roehrenbeck
   o Legislative Counsel - Rep. Walter B. Jones (R-NC)
• Carol L Vargo
   o Legislative Assistant - Rep. Jim McDermott (D-WA)

Next for AMA came the letter to Sebelius, which expressed similar concerns to the Boehner letter. In the letter, the AMA made it clear that Mari Savickis, Assistant Director for Federal Affairs would be in charge of their efforts with HHS and CMS. This was a clear play to maximize AMA’s strongest connection to HHS and CMS. Savickis served at HHS in multiple roles including:

  • CMS Detailee - Office of the National Coordinator for Health Information Technology (HHS)
  • Project Officer - Division of Medicare Payment Policy Demonstrations (CMS)
  • Special Assistant to Director for Center for Medicare Management
  • HIPAA Outreach Specialist
  • Assistant to Director of Physicians’ Regulatory Issues Team (PRIT)

Savickis clearly has both the institutional knowledge of how HHS works as well as the connections and expertise in the health IT departments to be the AMA’s strongest advocate. She is not AMA’s only connection to CMS and HHS, however, lobbyist Sylvia Trujillo recently served as a Litigation Attorney to CMS and an Assistant Regional Counsel to HHS.

A code set Civil War
AMA’s efforts were only one side of the debate. Across the battlefield, advocating in favor of ICD-10 implementation was a smaller association, the American Health Information Management Association (AHIMA). AHIMA, which represents health information professionals, came out publicly against AMA’s position.

AHIMA advocated for implementation arguing that ICD-10 is critical because it “is at the foundation of healthcare information changes underway in the United States,” stated Dan Rode, AHIMA’s vice president of advocacy.

[Related: The imminent industry association Civil War over ICD-10.]

In comparison to AMA, AHIMA’s lobbying operations were no match. AHIMA disclosed spending the minimum on lobbying, less than $5,000, and employed just two lobbyists.

During the debate AHIMA’s only lobbying efforts around ICD-10 were limited to issuing statements to the media against AMA’s actions. AHIMA has not disclosed any government lobbying on ICD-10 as its efforts have been primarily focused on the public relations front.

AMA and AHIMA are not the only organizations that have been involved in lobbying on ICD-10. In the last few years over 40 organizations have disclosed lobbying the government on ICD-10, including a mix of associations, health care providers, technology vendors, and other industry-related organizations.

In 2011, 12 organizations and eight Blue Cross Blue Shield affiliates disclosed lobbying related to ICD-10. This group includes notable associations such as:

  • American College of Surgeons
  • American Society of Anesthesiologists
  • Joint Council of Allergy, Asthma And Immunology
  • Healthcare Billing and Management Association (HBMA)

One of the groups listed is presumed to have a similar stance as AHIMA on ICD-10, HBMA, but chose not to be public in the media and other venues with their efforts.

The Medical Group Management Association shares the same concerns about the cost of ICD-10 as the AMA yet has refrained from joining the lobbying fight. In 2011 the organization doubled its lobbying expenditures going from $330,000 in 2012 to $670,000 in 2011. The group has given no indication they will unleash their lobbying resources on the ICD-10 issue but they are positioning themselves to be well-equipped should they decide to get involved.

Corporations have also disclosed lobbying on ICD-10, with two of the most notable being:

  • 3M: Disclosed lobbying for “ICD-10 Adoption” and “ICD-10 Implementation” in 2011. 3M produces software to help with ICD-9 to ICD-10 conversion and has already spent $4.5 million on its lobbying activity in 2011, making it a powerful player in the lobbying industry and potentially an ally for supporters of ICD-10 implementation.
  • MVP Health Care: Disclosed advocating concerns with negative consequences on costs associated with federally mandated ICD-10 program. The company has spent $160,000 on their lobbying activity in 2011 and is a potential ally of AMA’s in ICD-10 lobbying battles.

AMA’s strategy has yielded results. Its relationships and resources have postured it to be the most influential group in this debate, as evidenced by this latest HHS delay. Though it is yet to be seen whether or not the new compliance deadline will satisfy AMA, the group is well positioned long-term to handle any upcoming challenges its constituents may face.

Indeed, full implementation of ICD-10 is slated to take place on October 1, 2014 – but if groups like AMA adn perhaps others continue to lobby against implementation, future delays remain a possibility.

Alex Bronstein-Moffly is an analyst with the First Street Research Group in Washington, DC. The First Street Research Group reviews, investigates, and analyzes the data in First Street to publish reports and analysis on the people and organizations influencing policy in Washington, DC. Email: abmoffly@cqpress.com

More ICD-10 coverage:

If HHS delays ICD-10 just long enough, could the U.S. leapfrog to ICD-11? 

Could ICD-10 have as big an impact as the mortgage crisis? Yes, here's why

ICD-10's ten-year reign of fear

3 pieces of the ICD-10 conversion to outsource -- and the 1 you cannot

ICD-10 timeline: Extension can help and hurt health orgs