Physician Practices, Associations Pleased with ICD-10 Delay, But Concerns Remain

HHS’ proposal to move the implementation date for ICD-10 back one year to Oct. 1, 2014 has been met with gratitude and relief by physician practices. But even with the extra breathing room, healthcare organizations are concerned about the magnitude of the change, and are warning providers that they still need to start planning sooner rather than later for the new code set. 

The proposed rule, announced Monday, was at least partially created in response to “serious concerns” raised by medical groups about healthcare providers’ abilities to meet the original October 1, 2013, compliance date. “CMS and HHS believe the change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments,” the agency stated.

Depending on the size of a medical practice, the American Medical Association estimates the cost of implementing ICD-10 to range from $83,290 to more than $2.7 million per organization, InformationWeek reported. ICD-10 includes 68,000 alphanumeric, five- to seven-digit diagnosis codes, compared with 13,000 five-digit codes in ICD-9. In addition, in-patient procedure codes will mushroom to 87,000 with the new code set, up from only 11,000 in ICD-9. 

“Whether it’s 2013 or 2014, it’s still a significant impact on medical practices,” family physician Glen Stream, president of the American Academy of Family Physicians, told Physicians Practice. “My concern is for smaller practices that have limited resources to implement this big of a change.”

Robert Tennant, senior policy advisor for the Medical Group Management Association, said while the extension is a nice start, there are structural issues that need to be addressed. For one, CMS should conduct a pilot test of the new code set in various practice settings.

“When you do a pilot test, not only can you identify the problems and roadblocks before they go national, but you can prove and disprove ROI,” Tennant told Physicians Practice. “And if there’s no ROI, perhaps the government can make the decision whether or not to move forward.”

Additionally, Tennant says CMS needs to stagger implementation dates, for example, by having clearinghouses and health plans compliant on one date, and providers on another.

Michael Stearns, president and CEO of e-MDs, said the delay is helpful because it will give the healthcare technology provider time to incorporate into its EHR a technology called SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms), which he said will “markedly improve” clinical accuracy.

“It more seamlessly allows the switch from ICD-9 to ICD-10,” Stearns told Physicians Practice. 

Leann DiDomenico, administrative director of Performance Pediatrics, LLC, in Plymouth, Mass., said that while her practice is “as prepared as we can be” for the conversion to ICD-10, CMS has a duty not to rush into something without first getting some buy-in from all the major players.

“The AMA has been very vocal about its opposition to ICD-10, and as a practice manager as well as a patient and a tax payer, it makes me question the risk versus reward of ICD-10,” DiDomenico told Physicians Practice. “Of all the healthcare issues that need time, attention and money, is this one really worth it?”

However, DiDomenico admits she is relieved that ICD-10 is something she doesn’t have to worry about for a bit longer.

“Changes like this inevitably mean cash flow will slow a bit while the industry navigates its way through the implications of the change,” she said. “For example, when 5010 changed over, we received delayed payments or the wrong fee schedule from a few payers for a few weeks. Also, our insurance real-time eligibility through our EHR and clearinghouse vendors hit a few snags which slowed us down. It’s all straightened out now, but it was enough time and effort to fix to frustrate me.”

Physician Stephen Rockower of Capitol Orthopaedics & Rehabilitation, LLC, in North Bethesda, Md., said the longer the delay, the better.

“As is being shown by the very slow conversion to EHRs, ICD-10 will take a significant time to impose on physicians,” Rockower told Physicians Practice. “It is akin to telling somebody that the new proper way to drive a car is to use your left hand to push the accelerator, which now is located in the backseat, and you have no mirrors, and if you do it all wrong we are going to fine you.”