So the American Medical Association is asking the Centers for Medicare and Medicaid Services to ease off the pedal a bit on ICD-10. Pushing the deadline back by two years would be a good start, according to the AMA, but just a start.
CMS should use that extra time, it adds helpfully, to conduct a much-needed cost-benefit analysis, many of which have already been done (I just read through a RAND study commissioned by HHS way back in 2004) but need to be done again.
Note that the minimum delay the AMA is seeking, until October 2015, is a two-year delay from the 2013 implementation deadline, itself a delay from the original, original deadline of October 2011. If the guns had been stuck to, the industry would be in the middle of what the RAND study and similar research predicted would be a perplexing, post-transition aftermath of up to five years, at the end of which positive benefits in the form of fewer erroneous and “exaggerated” claims, as well as better disease management and more data-driven best practices, would kick in.
Well, now that we’re back in reality, that troubling time has been punted to what is becoming an ever-more distant future. CMS has officially pushed ICD-10 back to 2014, but all dates are elastic when it comes to adopting industry standards.
While much has been written about how the AMA lacks the political muscle it used to, it’s still got something left in the tank: I’m still wiping the egg off my face for a print feature I’d written in June 2010 about the Red Flags rule going into effect, which would have required providers to have specific compliance plans implemented to safeguard consumer data commonly used for identity theft and medical identity theft. I sent that to the printer the day before the AMA and others sued the Federal Trade Commission over the rule and kept up the pressure. Eventually, President Obama signed the Red Flag Program Clarification Act of 2010 which exempted health care providers and others from having to comply with the rule.
The reason I’m mulling it over is to lay bets on whether the industry will ever be coding in ICD-10. When I read over the AMA’s concerns and questions and calls for studies about ICD-10, I come to one conclusion: The association wants all its members to pick up a shovel, together dig the deepest, darkest hole they possibly can, and throw ICD-10 into it. The stated reason for the two-year delay request, that there’s too much going on right now, what with meaningful use and the transition to HIPAA 5010 transaction sets and health reform (maybe) and accountable care and bundled payments, and, well, other stuff too, is a bit disingenuous, because there’s always going to be something going on, including a potential Stage 4 to the meaningful use program in 2018 and other regulations (maybe FDA regulation of electronic records?) that are being thought up right now in the basement of some government agency.
Mind you, the AMA and its allies in this tussle (the Medical Group Management Association and a slew of other medical societies) have their reasons to throw a wrench in the works, many of them compelling for their constituents. It’s hard to see a future where ICD-10 granularity doesn’t result in lower reimbursement rates. And as of now, it’s an unfunded mandate, and even the most optimistic advocate will concede it’s going to be hideously expensive and cause productivity losses and revenue disruptions for an indeterminate period (that perplexing post-transition aftermath I noted earlier).
But let’s just call it like it is. It would be better if the AMA issued a release saying “The AMA Calls for the Death of ICD-10” and had ended it, instead of clogging up e-mails boxes with more calls for delay, which it will inevitably do. The problem with this perpetual cycle of political jockeying is that it punishes the organizations that are inclined to take the government at its word and invest the time and resources to actually do what the government keeps saying it’s going to make them do. This is a very dangerous game being played, and unfortunately it truly feels like a game, like it did during the agony of birth for myriad HIPAA regulations.
We need some resolution. Kill ICD-10 or negotiate with the AMA and other big players to have a deadline that everyone signs on to, with their signatures written in blood. If the industry can do that, it will create a blueprint for addressing future regulations that are hugely controversial but, in the end, have to be adhered to.
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