ICD-10: Ready to waste more money?

By Anthony Brino
12:32 PM

A new Republican majority focused on curbing regulation may give the healthcare industry the opposite of what most are looking for: uncertainty. Or they could turn to a fairly simple option to help the stakeholders long resistant to ICD-10.

"ICD-10 will never happen, we'll just keep spending money on it."

So one health system CIO told a colleague at the College of Health Information Management Executives’ (CHIME) recent gathering, before the November elections ushered in a GOP majority in the House and Senate and raised new questions about the viability of ICD-10.

The American healthcare system was originally supposed to adopt ICD-10 in 2011, then the Department of Health and Human Services moved the proposed implementation date to 2013, and then delayed it again for a year, to October 2014.

Then, this past spring, tucked into annual Medicare bill that temporarily postpones long-ago mandated physician reimbursement decrease, Congress forbade HHS from implementing ICD-10 until October 2015, in what some saw as a concession to a political constituency and a long-time ICD-10 skeptic, the American Medical Association.

If ICD-10 does takes effect next fall, it will be will be 20 years after the U.S. government first agreed to adopt the World Health Organization’s international disease classification system, and more than a decade after the likes of Australia, Canada, China and others actually adopted it.

But the October 2015 implementation date is no done deal, given the GOP’s opposition to new government mandates and the AMA’s resistance.

“The key factor will be seeing industry progress during the next six months,” said Stanley Nachimson, a health IT consultant and former health IT advisor at CMS. “If CMS can report to the industry and Congress that providers, plans, and vendors have made progress and are moving toward the October date, then there will be no reason for a delay. If there is little progress, then I think either CMS or the Congress may step in.”

The trouble is that many insurers and large hospital systems have been ready for ICD-10 for a while — but not so independent physician practices or their trade group the American Medical Association.

The high costs of switching are “why the AMA and just about every physician really is opposed,” according to Carl Natale, editor of ICD10Watch, a Government Health IT sister publication.

But if that’s the case, there is a fairly simple solution.

“If Congress finds a way to fund implementation costs for small medical practices and independent physicians, we're going to be using ICD-10 codes [in 2015].” However, he cautioned, “if someone crafts an ICD-10 Stimulus Act that finds some real money to help the small healthcare providers, they will need to persuade Congress to take the money from somewhere else.”

That’s the carrot. There's also a stick.

If lawmakers are interested in controlling waste and fraud, they’ll realize that preventing it requires a modern coding system, according to Natale.

“If a politician makes the argument that $X is being wasted because ICD-9 codes do not adequately reveal healthcare waste and fraud, then it's going to real hard to stop ICD-10 implementation."

Either way, most lawmakers probably know that many millions have already been spent on ICD-10 — some might call it waste, given the resources sucked up by the delays and restarts.

One more year of ICD-10 implementation delay could cost anywhere between $1 billion and $6.6 billion across the healthcare industry, according to estimates by the Centers for Medicare and Medicaid Services.