Four months until the ICD-10 deadline, and the American Medical Association is peddling the logic of waiting for the next iteration of the disease coding system, or at least delaying a bit more.
"Let's just get to ICD-11 and get it done properly," said Steven Stack, MD, the incoming president of the American Medical Association in an interview with Healthcare Finance News.
"We believe the problems associated with ICD-10 are so substantial, our policy is we should not move forward," said Stack, an emergency physician based in Lexington, Kentucky.
The AMA has long opposed the transition to ICD-10 on the grounds that it is an unfunded administrative mandate on small and independent physicians. The transition in the U.S. has already been delayed three times since its first would-be implementation date of 2013.
Now, the AMA is proposing the idea of waiting until the rest of America's global peers adopt ICD-11 (which most likely would not be until 2018 at the earliest) or at least making ICD-10 more a phased-in transition with a period of dual coding or waived fines.
The AMA is backing a bill by Texas Republican Representative Ted Poe, the Cutting Costly Codes Act, that would temporarily delay the transition and require the Department of Health and Human Services to identify steps to mitigate problems with future adoption. Another proposal, from Louisiana Republican Senator Bill Cassidy, MD, is to go ahead with the October 2015 rollout, but delay the penalty phase for two years
"If Health and Human Services moves forward and implements, then we say, there should be a period in which providers should be held harmless," said Stack. The legislative changes, particularly another delay, are a long-shot, although Stck suggests not ruling them out. "There's an eternity between now and October in legislative parlance."
On the logic of waiting for ICD-11, Stack has a multi-pronged argument. One, he argues, the U.S. is probably the only country where ICD codes are used for reimbursement to physicians, so there is enormous pressure on documentation that some docs fear will not go away.
For another thing, "the rest of the world has been on a different variation of ICD-10. Each nation modifies it at the national level."
Canada, Stack said, has about 17,000 codes under ICD-10, about the same number in the U.S. under ICD-9, and well below the 68,000 that the U.S. version of ICD-10 will bring.
"ICD-10 is problematic, it requires a level of specificity and precision clinicians say we don't think we're going to be able to provide," Stack said, offering the example of a major leg bone. Under ICD-9, there are 16 codes to diagnose a broken femur--compared to 750 ways under ICD-10. "There are many instances we don't know that level of detail," he said.
Three years ago the AMA wasn't even commenting on the possibility of waiting for ICD-11, although even then, there were observers, if not supporters, of the idea, pointing out some things to consider--namely that ICD-11 "will be something ICD-10 cannot: A 21st Century classification system."
In 2012, HIMSS Media executive editor Tom Sullivan probed the costs and benefits of waiting, in an essay asking the question: "Could the U.S skip ICD-10 and leapfrog directly to ICD-11?"
With ICD-10, "We're moving up 20 years, which is an improvement, but we're still not in 21st Century thinking as far as an underpinning of ICD-10," said Chris Chute, MD, then at the Mayo Clinic's bioinformatics division, and now chief health information research officer at Johns Hopkins Medicine.
At the same time, cautioned Chute, then the chair of WHO's ICD-11 Revision Steering Group: "To change at this point, given that we are a year and a few months away from the magical transition date, would be, I submit, vastly more disruptive than just staying the course at this point." That was in February 2012.