Right Now

Today, Sens. Tom Coburn, M.D. (R-OK), John Barrasso, M.D. (R-WY), John Boozman, O.D. (R-AR), and Rand Paul, M.D. (R-KY) introduced a bill to stop the adoption of ICD-10 codes which will increase compliance costs across our health care system. The “Cutting Costly Codes Act of 2013,” S. 972, would prohibit HHS from implementing ICD-10 diagnosis codes (as currently required due to HIPPA).

Estimates regarding the additional costs of the implementation of ICD-10 have varied, but one study from the American Medical Association, the Medical Group Management Association, and others has pegged the adoption costs for a small practice at $83,000, ranging up to $2.7 M for a typical large practice. Ernst & Young has noted that HHS pegs the cost of the coding conversion at $1.6 billion, but “costs won’t even break even until 2018.” A September 2010 estimate from the Association of Health Insurance Plans estimated “total system-wide cost” just for health insurance companies could be as high as $3 billion.  One industry survey found that the top cost-related concerns for adopting ICD-10 are “updating relevant IT systems, training staff, increased documentation, replacing antiquated IT systems, and hiring new employees.”

The implementation if ICD-10 will be particularly burdensome on practicing physicians—a group who is already very pessimistic about the future of medicine. Deloitte’s 2013 survey of physicians found roughly two-thirds of physicians expected their colleagues will retire earlier than planned in the coming months, while three in four physicians believe the best and brightest students likely will not consider a career in medicine.

The Deloitte survey also found that one in four physicians said they planned to limit Medicare patients if there were payment changes. Under current law, physicians face a number of looming penalties and payment reductions under Medicare’s PQRS initiative, Electronic Prescribing (eRx) program, and EHR program.  The combined effect of these potential payment penalties on an individual practicing physician is massive. Additionally, physicians face a number of systemic changes and challenges related to implementation of the Patient Protection and Affordable Care Act.

In May of 2012, Dr. Coburn, along with co-author Dr. Jason Fodeman, penned a white paper on the problems with ICD-10.  Dr. Coburn’s white paper preceded an announcement last summer from HHS that hospitals and physicians have an additional year (October 1, 2014) to adopt a new generation of diagnosis codes.  In the white paper, Dr. Coburn:

  • argued that “the costs of [the ICD-10 coding] changeover for hospitals already operating under narrow financial margins will be substantial,” and “the adoption of the codes will, by default, force physicians to devote more time and energy toward coding, which may detract from patient care.”
  • explained that while “the compliance costs of ICD-10 are tangible, the benefits are much more esoteric,” and worried “ICD-10 could indirectly accelerate the vertical integration of medicine and exacerbate the physician shortage.”

The codes are indefensible. Code V91.07XA, for example,  involves a "burn due to water-skis on fire.” There are 312 animal codes in all, compared to 9 in the international version. There are separate codes for "bitten by turtle" and "struck by turtle." (You can search the codes here).

The complexity, costs, danger of legal entrapment, and additional strain on our burdened health care system led Dr. Coburn to conclude that while “health care providers struggle to navigate the murky waters of health care reform,” HHS should halt ICD-10 implementation.   

Supported by:

The American College of Rheumatology

American Medical Association

American Association of Orthopaedic Surgeons

McBride Orthopedic Hospital

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