New Rule Creates Avalanche Of Time-Wasting Paperwork For Doctors
By GRACE-MARIE TURNER AND TYLER HARTSFIELD
Posted 05:14 PM ET
An avalanche of paperwork is about to fall on doctors
Is there a code for that?
Were you hit by a falling kayak? Injured while baking, vacuuming or spending too much time in a deep freeze? Encountered a lamppost for the second time? Were you bitten by a turkey? Never fear, the ICD-10 is here.
Starting this October, your doctor will be required to record precisely whether you were bitten or struck by a parrot, macaw, chicken, turkey, or any "other psittacines," or encountered any one of 140,000 other specific medical conditions, injuries or diseases.
This will be a significant and disruptive change to the health sector.
Medical providers who participate in Medicare, Medicaid and any other federal health program must follow highly detailed coding requirements to get paid — on top of trying to wade through the mounting complexities of ObamaCare.
For 30 years, the U.S. has used the ninth revision of the International Classification of Diseases (ICD-9), but the U.S. Department of Health and Human Services (HHS) is requiring virtually all hospitals, laboratories and medical offices to convert to the more complex ICD-10 coding system on Oct. 1.
Physicians and hospitals were hoping that the avalanche of new coding requirements would be delayed, but the director of Medicare said last week they will go into effect as scheduled.
Dr. Susan Turner, president and CEO of Medical Group Management Association (MGMA), says the transition will be "one of the most complex and expensive changes our health care system has faced in decades."
The ICD-9 has about 17,000 codes, while the new ICD-10 will have more than 140,000. These cumbersome new administrative responsibilities will take away from the time doctors can spend with their patients.
When Canada recently converted to its own version of ICD-10, it experienced a "large learning curve and loss in productivity." A project analyst compared learning the coding concepts to "learning to read Greek."
Michelle Bamford, regional coordinator of clinical information services with the Vancouver Island Health Authority, said the "average coding time per record went from 12-15 minutes to 33 minutes" and the "coding backlog increased from 64 days to 139 days." The productivity levels "never returned to pre ICD-10 levels," she added.
The Obama administration supports the move to ICD-10, citing the need for much greater clinical detail and specificity.
The Centers for Medicare and Medicaid Services at HHS claims the new system of data collection will lead to improvements in "measuring the quality, safety, and efficacy of care; designing payment systems; conducting research; setting health policy" and other benefits.
While CMS is optimistic, many doctors are not. In a letter to Marilyn Tavenner, the administrator of CMS, Dr. Jeff Terry, chairman of Alabama's delegation to the American Medical Association, said "the statistics generated by ICD-10 will not be good enough to do any scientific study."
Terry also fears that the administrative burdens levied by the new coding system "will result in the untimely retirement of many good, dedicated physicians who are tired of government imposing regulations that do not help patient care."
In addition to the huge administrative burden of the transition, physician practices will also experience substantial costs to comply with the new requirements.
In a recent letter to HHS Secretary Kathleen Sebelius, Dr. James Madara, CEO of the American Medical Association, said it will cost a small practice up to $226,000 to comply. And there is no opportunity to phase in the new system and iron out glitches. (We saw how this worked out with the ObamaCare website ... )
Because this coding system directly facilitates payments, physicians who do not transition on time will experience a delay or cessation of payments. To weather this transition, CMS suggests that small and medium-size practices should have access to "reserve funds or lines of credit to offset cash flow challenges."
The Healthcare Information and Management Systems Society recommends "a minimum of six months of cash reserves to mitigate revenue impacts over the ICD-10 transformation period." Few physician practices have access to those resources.
Legislation is before the House and the Senate to block the implementation of ICD-10 and give small and medium-size practices a much-needed reprieve from yet another bureaucratic nightmare.
No votes have been scheduled, but the clock is ticking for doctors.
Somehow there doesn't seem to be a code for "physician buried under an avalanche of paperwork."
• Turner is president and Hartsfield is a policy analyst at the Galen Institute, a nonprofit research organization focusing on free-market ideas for health reform.