Why not just skip right to ICD-11?

By Tom Sullivan
10:51 AM
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More than a nagging presage: The United States is on the verge of repeating a past mistake – and to the tune of billions of dollars. That’s right, I’m talking about ICD-10.

The problem is that ICD-10 is a classification system based on 1980’s theories of medicine and technology, meaning it will advance the U.S. a couple decades forward from the 1960’s-inspired ICD-9, but by no means bring our healthcare system into the 21st Century.

While industry associations battle over the code set’s future, and HHS figures out when the new compliance deadline will be, the World Health Organization (WHO) is already moving toward ICD-11, promising a beta in 2014 to be followed by the final version in 2015. Should that slip until 2016, U.S. health entities will still be settling into ICD-10 when ICD-11 arrives – meaning that shortly thereafter, we will be right back where we are now: Behind the times, on the previous ICD incarnation.

Are we repeating our own faulty history?

“That almost assuredly will be the case,” said Chris Chute, MD, DrPH, who spearheads the Mayo Clinic’s bioinformatics division and chairs the WHO’s ICD-11 Revision Steering Group.

Even worse, ICD-11 will be within reasonable grasp. The quagmire that U.S. healthcare providers and payers are in, however, is that by most accounts – even Dr. Chute who professes to be “no ICD-10 proponent” – we are simply too far down the road to turn back now.

So the reasons for spending enormous time and money, rather than holding out for ICD-11, are purely political in nature. Two years of asking, and no rock-solid technical reason for needing to implement ICD-10 en route to ICD-11 has presented itself. Sure, I’ve heard the Windows OS upgrade analogy, and all about the enigmatic “bridge” between the two versions, but neither is convincing or specific.

When asked at HIMSS12 about the possibility of leapfrogging ICD-10 and instead adopting ICD-11, Sue Bowman,  AHIMA’s director of coding policy and compliance, pointed out that it took the U.S. eight years to customize ICD-10 for our own purposes and, so it follows, that ICD-11 will not be ready for the U.S. once the final version ships. And I’ve read of how the ICD-10 cartographers discussed while writing the final rule holding out for ICD-11, then decided against it largely based on estimates that customization would take 5 to 6 years after ICD-11 arrives.

But that was 2008, CMS was still claiming a 2009 compliance deadline, ICD-11 was some five years in to the future. There would be no overlap or near miss between ICD-10 and ICD-11. Indeed, the ICD landscape today is different.

And are we as a nation really incapable of fast-tracking ICD-11 clinical modification, beginning with the ICD-11 beta, so that ICD-11 is tailored to fit U.S. healthcare payers and providers as soon as it’s ready for everyone else?

Consider the lexicon Chute uses to describe the WHO’s intent for ICD-11 – phrases such as semantic web-aware, rich information spaces, linkages to other classification systems i.e. SNOMED-CT, foundation layer, fabric, ontology – terms that pepper the more technical IT journals. Those constitute an appealing blend of 21st century thinking about both medicine and technology. ICD-10, meanwhile, was created before the Internet was even widely-used.

Also dated are the cost estimates for ICD-10. The oft-quoted RAND Science and Technology Policy Institute report projected ICD-10 would eat up as much as $1.15 billion. That was conducted in 2003 and published in 2004, while an estimate surfaced from AHIP in 2010 that insurers alone would spend as much as $3 billion getting to ICD-10. In late February, regulatory compliance and exchange vendor Edifecs polled attendees at an ICD-10 conference it hosts and among the findings was potential for a one-year delay itself to cost the industry anywhere between $475 million and $4 billion.

The only thing that’s clear today is that there’s no telling how much ICD-10 will cost the broader healthcare industry; all we know is that it will be a daunting sum, no doubt squarely in the billions if not tens of billions.

So wouldn’t those billions be better spent on ICD-11? After all, that old saying about the dictionary – that it’s obsolete by the time it gets printed – might just as easily apply to ICD-10.