That's the question facing AMA's Board of Trustees. Under the organization's governance structure, the 520-member House of Delegates creates policy and the board implements it, says board chair Robert Wah, M.D. "If we interpret their policy incorrectly, they'll be the first to tell us," he tells Health Data Management in an interview.
But there's no ambiguity in the delegates' directive--they want ICD-10 stopped. Asked if there is some wiggle room for the board, Wah responds that delegates wanted to state clearly in the resolution that they want the AMA to work to stop implementation. "That is an aspirational statement," he adds. "Pragmatically, everyone recognizes the limitations of what can be done."
The resolution, Wah says, is indicative of the regulatory pressures on physicians today. They understand how accountable care organizations or medical home practices can improve patient care. But having to code a head injury as resulting from being hit by a baseball bat or a hockey stick--and more specifically an ice hockey or field hockey stick, "it's a little harder to see how that will improve the care of my patient."
Through the resolution, AMA members are spreading the word that they are frustrated with so many regulations being implemented at the same time, Wah contends. Further, it is clear that many state Medicaid agencies aren't ready for the HIPAA 5010 transactions set, which is a precursor to ICD-10, "so it's not just physicians that are maxed out," he adds.
Asked specifically if the board could decide to push members toward working for a delay in ICD-10 compliance, Wah notes that the board just got the House of Delegates' directive. "This is not the only policy passed by the House and we have limited resources. We will be looking at all our options."
What's important, he adds, is the resolution is shining a light on the issue of physicians not being convinced of the need for ICD-10, and the need for better communication within the industry of the benefits of the code set. Right now, many physicians don't see a return on investment for themselves or their patients, who would pay the price through decreased time with the physician or increased prices to offset the cost of ICD-10 compliance. Many physicians, Wah says, view ICD-10 as a system where someone gets the return on investment but it isn't the patients and physicians who have to make the investment.
The cost of meeting all the government edicts is skyrocketing, and payments for physicians are due to fall by 25% on January 1. Physicians are finally beginning to revolt - refusing medicare contracts in California, resigning en masse from hospitals in Pennsylvania, and increasing medicare/medicaid refusals dramatically. ARRA and the PPACA are breaking the back of medicine, intentionally, and it's a safe bet that no one (except big insurers, HIT vendors and nurse practitioners) will like what arises from the ashes.