ICD-10 Debated on Capitol Hill; Most in Favor of 2015 Implementation

The House of Representatives’ Energy and Commerce Committee’s Subcommittee on Health held a hearing on the transition to ICD-10 this week that ended up being lopsided in favor of moving forward with the transition.

The panel included stakeholders from the healthcare industry, including practitioners, advocacy groups, and vendors. Most members of the panel were in support of keeping Oct. 1, 2015 as the official deadline for ICD-10 implementation. Only one, William Jefferson Terry, M.D. from the Mobile, Ala. Urology Group, represented an anti-ICD-10 voice. Although a few doctors in Congress, most prominently, Rep. Larry Buschon, M.D. (R-Ind), spoke out against the ICD-10 transition.

Some medical groups, such as the Medical Group Management Association (MGMA) and the American Medical Association, are pushing for a third delay of the compliance deadline for the code-set. Neither group had official representatives on the panel, although Dr. Terry has been associated with the AMA in the past. He was speaking on behalf of the American Urological Association at the hearing.

The debate centered on the cost and benefits of the ICD-10 transition. John Hughes, M.D. Professor of Medicine at the Yale School of Medicine, said that ICD-10 will accurately describe information on procedures that will ultimately lead to new discoveries and treatments. Sue Bowman, the senior director of coding policy and compliance for the American Health Information Management Association (AHIMA), listed the many improvements that will come from ICD-10 including analysis, ability to measure outcomes, public health measures, and much more.

Cost became a hot topic. Those like Dr. Terry said the transition to ICD-10 was costing physicians. Many, he said, were opting to retire early than face ICD-10. He recommended an implementation that should be carried out over 2-3 years. Buschon said that in his own life, the administrative costs of ICD-10 led to his practice being sold to a hospital.

Having cited a study that said the cost of transition would be up to $250,000 for small practices, some disputed his claim it would be this overwhelming. Rich Averill, director of public policy at 3M Health Information Systems, said that another study had shown the cost for small practices to on average about $8,000.

Many derided the ICD-9 code-set as out of date. Bowman said it doesn’t fit with a 21^st century health system. Averill noted that when ICD-9 was implemented, you could still smoke in a room with the patient. “The reality is with ICD-9 we often don’t know what really is wrong with the patient or what procedures were performed. ICD-9 codes like a repair of an unspecified artery by an unspecified technique are virtually useless for establishing fair payment levels or evaluating outcomes,” he said.

Hughes at Yale Medicine testified on his own frustrations with using ICD-9. “I have been frustrated many times at ICD-0’s inability to specify the exact nature of a complication, its extent, its location, and how it was treated,” he said. He said it doesn’t have the capacity to describe new technologies. Also speaking in favor of the transition was Kristi Matus, chief financial and administrative officer of Watertown, Mass.-based vendor athenahealth, Edwin Burke, M.D. a practicing physician, and Carmella Bocchino, of the America's Health Insurance Plans (AHIP) group.

On the specificity of the code-set, Terry said that the ICD-10 was too granular. He noted that there were more than 200 codes for diabetes alone. He said this increased granularity would lead to reduced production from physicians. He said the codes were statistics and not for people who want to practice.

After initial testimony, Rep. Joe Pitts (R-PA) took a vote asking panelists if the health industry was ready to implement ICD-10. Everyone, except Terry, said yes. When he asked if another delay should be opposed, everyone again said yes except Terry. Pitts and Rep. Kathy Castor (D-FL) both vocally opposed another delay to implementation.