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Coalition for ICD-10 Convenes on Capitol Hill: Event Recap

The Coalition for ICD-10 hosted a Capitol Hill briefing for House and Senate Congressional healthcare staffers on September 23, 2014 that featured a panel of speakers representing a broad spectrum of the healthcare community. Physicians, hospital executives, physician office managers, researchers and health plans all urged the adoption of the ICD-10 coding update in October 2015.

Summarized below is the commentary from each speaker at the event, as well as questions from the audience and responses from the panel speakers.

Coalition for ICD-10 Convenes on Capitol Hill to brief Congressional Staffers

The moderator for the panel was Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director, Coding Policy and Compliance for the American Health Information Management Association (AHIMA).  Bowman described the ICD-10 coding system and compared it to the much older ICD-9, which was developed in the 1970s.  Bowman noted that this outdated code set cannot support the health information needs of our current healthcare system and is compromising the value of our healthcare data.  The modernized ICD-10 code set, however, can keep pace with today’s changes in medical practice and healthcare delivery through higher quality information for measuring service quality, outcomes, safety and efficiency.  Bowman said that it will enable better patient care, improve the ability to study patient outcomes, and aid in better public health and quality reporting and research.  Bowman outlined the benefits for healthcare providers, including  more accurate reflection of clinical complexity and severity, improved ability to identify high risk patients that require more intensive resources, more accurate representation of provider performance, less misinterpretation by auditors, and more accurate and fair reimbursement.  Bowman spoke about the significant investments to date by much of the healthcare industry – investments that have been lost or need to be replicated due to the delays.  She noted that the Department of Health and Human Services (HHS) estimates the cost to the healthcare sector of the one year delay to be $6.8 billion – a 30 percent cost increase.  For the association she represents, the delay is jeopardizing employment opportunities for the over 25,000 students in health information management that are exclusively trained in ICD-10.  According to Bowman, “each delay is disruptive for healthcare delivery innovation, payment reform, public health and healthcare spending.”

The first panelist to speak was Jeffrey F. Linzer, Sr., M.D., Professor of Pediatrics and Emergency Medicine at Emory University School of Medicine in Atlanta, Georgia.  Dr. Linzer shared a partial list of the medical academies and societies that participated in crafting ICD-10, emphasizing that the compilation of the new code was developed predominantly by “the House of Medicine.”  He noted that many of the medical specialties sought to take advantage of increased clinical specificity in ICD-10 and asked for codes to track specific conditions to ensure the code set reflected the work of these specialty societies.  For example, roughly 25 percent (over 17,000) of the new codes are orthopedic specific codes.  He provided examples of critical new codes, such as one that describes under-dosing for pediatric patients, which would allow pediatricians to work with families to address better patient care and outcomes.  He described ICD-9 as “no longer robust enough to meet current and future healthcare needs.”  In comparison, ICD-10 reflects advances in medicine, current medical terminology and classification of diseases, more specificity such as laterality and episode of care, and can help support in making clinical decisions.  The improved specificity aids in measuring healthcare services and quality metrics measurement, as well as detecting fraud and abuse.  It also helps improve public health surveillance, epidemiological research, and mortality and morbidity diagnosis data comparisons.  He noted that the cost to transition is “not that substantial” – around $2000 per physician.  He shared that many physicians are starting to learn to document using ICD-10 now, are getting used to it, and should be ready for the 2015 transition.

Gail Eminhizer, CMM, CGCS, HITCM-PP, Practice Administrator for the Digestive Health Associates of Northern Michigan in Traverse City, Michigan addressed the benefits of ICD-10 adoption, as well as the cost of the delay, for physician offices, including small physician offices.   Eminhizer noted that there are many tools online, including from specialty societies and CMS, to help small providers train and transition to ICD-10.   She provided an example where the current ICD-9 code did not provide all of the information needed by a payer to understand the procedures done by the physician to treat the patient.  Due to this, currently, the claim would be considered “pending” until the payer and provider would conduct additional patient information exchanges to explain why multiple procedures were needed for that specific patient.  However, she noted that ICD-10 would provide the detailed information up front, reducing the administrative burdens for physician offices.  According to Eminhizer, with ICD-10, the physician offices will be “paid accurately, timely, and without additional time and documentation.”

Sandra J. Wolfskill, FHFMA, Director, Healthcare Finance Policy, Revenue Cycle MAP, for the Health Financial Management Association, expressed appreciation to CMS for the recent announcement of upcoming end-to-end testing on ICD-10.  She noted that the payment system is changing with bundled payments, ACOs, reference pricing and more.  The current system cannot handle this change and a new code system based on value versus volume is needed.  She noted the importance of having a code system that yields clean, payable claims as well as information to provide accuracy for setting quality scores. ICD-10 has the granular level of data to provide insights into delivery of care at the patient-specific level, such as severity measures.  She concluded by noting that “continued delays will definitely result in increased expenditures.”

Thomas J. Pacek, Vice President of Information Systems and CIO at Inspira Health Network in Bridgeton, New Jersey, provided an overview of the impact of the delay for hospitals.  Pacek noted that transitioning to ICD-10 was a priority for Inspira and they had invested $2.8 million to be ready before the delay happened.  The delay has also impacted Inspira’s planning and education to support strategic initiatives.  Unfortunately, Inspira will have to re-spend this money to retrain and recertify coders.  ICD-10 provides greater information for the health system and they need the data to share between the physician offices and hospitals to improve patient care and care management.  Pacek noted that Insipra was working to help educate the community providers so they can all transition together; according to Pacek, “we are not going to let them fail on that side of the fence.”  He noted that they “can’t afford another delay” and urged that adoption occur in 2015.

John S. Hughes, M.D., Professor of Medicine at Yale University School of Medicine in New Haven, Connecticut described the many benefits that a more modern, comprehensive code set could provide for medical research.  Dr. Hughes noted that under ICD-9, the same code is used for both a patient with a planned admission and successful repositioning of a stimulator lead for deep brain stimulation and a patient with an emergency admission leading to an unsuccessful attempt to stem a leakage after an intracranial ventricular shunt implant to treat a traumatic cerebral hemorrhage. In ICD-9, there is no ability to identify different types of nervous system devices, implants, grafts, or types of complications associated with them.  However, under ICD-10, the type of device, type of device complication, and nature of procedure are distinctly coded.  This information is needed for researchers to be able to compare or contrast medical procedures or technologies to determine potential patient outcomes or best practices.  The current system fails to provide the levels of data needed for researchers.

Dennis Winkler, Director of Technical Program Management and ICD-10 for BCBS of Michigan described the importance of a smooth transition to ICD-10 for the health care provider and payer community and the effort underway to achieve this in Michigan.  He said that from the payer perspective, there is a needed equilibrium between the payer and provider communities, and the objective is that when ICD-10 “goes live” that this equilibrium or balance be maintained.  Winkler noted that one of the main concerns for ICD-10 transition is provider readiness.  Thus, the goal is to help resolve provider problems, address concerns and aid them in formulating solutions.  BCBS MI is part of a collaborative in the state between health plans, vendors and providers to help identify “at risk” providers, help them understand simple, available, cost-effective ways to transition and lessen anxiety about the change.  Testing had begun in January 2014, but it stopped after the delay was announced.  This is unfortunate as providers were on the way to being ready and they had begun to identify those that needed additional attention and assistance.  Winkler mentioned that they plan to continue the effort in Michigan to be ready for 2015 and hope to replicate the effort in other states.



What is the basis for opposition to the change to ICD-10?

Bowman noted that there has been significant misinformation spread about the cost of adoption and what is involved to make the change.  Bowman also noted the level of frustration by the provider community of all they currently have on their plate and ICD-10 is viewed as one more item to adopt.  Dr. Linzer noted that the physician community should not be afraid of the additional specificity – rather, they need the additional information to improve patient care and reimbursement.  He used the example of asthma and how ICD-10 codes justify the type of treatment and frequency of appointments needed – which will end the questioning and denials by payers for patient treatments and appointments.  Bowman noted that ICD-10 adoption does not replace the current use of CPT for physician office and other outpatient reimbursement.


What is the cost of ICD-10 adoption for physicians?

Bowman referenced an article outlining a recent survey by AAPC which found that “the coding industry is much more ready for ICD-10 than previously believed, and the cost to prepare is proving less expensive than was claimed.”  According to the article, “on average, ICD-10 is costing a provider about $1,600.”  Eminhizer agreed and said that the costs are not as high as some are proposing.  She noted that the biggest expense is the physician documentation training, but her practice is prepared.  Winkler noted that for a small practice, they only use a small subset of codes today and just need to map those specific codes to be ready for ICD-10.  Just as they do today, if something unique to the practice codes up, they may have to look up a new code once in a while – but that need will be the same with ICD-10 as it is with ICD-9.


Will there be another push to delay again?  Has the delay caused inertia, impacting ICD-10 readiness?

Pacek responded that there are probably some still asking for delay – but he fears any more delays.  Delays cost money and it will be tough to get the system to re-engage if there are any more delays.  He and others on the panel noted that there aren’t any other good alternatives to ICD-10 and the system cannot wait anymore.  In response to anyone pushing for delay, Dr. Linzer said, “I hope not.”  The House of Medicine asked for this code set – helped write this code set.  “We shouldn’t have to wait because one or two groups are uncomfortable.”  Winkler noted that so many are investing in preparation– and no one actively working to be ready would ask for a delay.


What is the impact of ICD-10 on Meaningful Use Stage II?

Pacek said that ICD-10 is not having a meaningful impact on it.  More data is needed, but they can meet it now with ICD-9 – it is not specific to ICD-9 or ICD-10.  However, Pacek noted that at Stage III, the paths will cross and it will be much better to have ICD-10 for that stage.


Reported by Megan Ivory Carr, 3M Government Affairs, for the Coalition for ICD-10

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