Internists oppose the switch to ICD-10-CM, too

In yesterday's post, we highlighted the opposition of family physicians to the switch to ICD-10-CM.

It turns out that internists, too, are against the switch. Dr. Yul Ejnes wrote a letter (pdf) on behalf of the American College of Physicians (ACP) opposing the switch. Like the AAFP letter (pdf), Ejnes' letter was in response to the proposed rule to mandate a switch.

Here are some highlights from internists' opposition to the switch:

The College urges the Centers for Medicare and Medicaid Services (CMS) to suspend plans to adopt ICD-10-CM, the diagnosis code portion of the ICD-10 set, for physicians and other outpatient entities. Adoption of this diagnosis code set in the ambulatory setting is unwarranted as the collective costs far out-weigh the benefits...The burden associated with implementing ICD-10-CM is likely to exacerbate the crisis in the primary care workforce.

The administrative changes and related costs of ICD-10 adoption at this time will place a significant burden on internal medicine and all other physicians; with the burden especially acute for primary care physicians. This is at a time when physician practices—small primary care practices--are already struggling to meet:

• other regulatory requirements (e.g. other HIPAA related initiatives including implementation of the National Provider Indicator (NPI) and the upcoming adoption of the 5010 transaction standards);
• calls for increased adoption of HIT (e.g. e-prescribing and interoperable electronic health records (EHR) systems) including the recently passed Medicare e-prescribing bonus that transitions into a payment reduction; and
• expectations to participate in various pay-for-quality initiatives such as the Medicare Physician Quality Reporting Initiative (PQRI).

Providing more diagnostic code options is not guaranteed to generate better data or patient care.

Indeed, the problems with ICD-10-CM that we have outlined here make it certain that our data will not be better if we switch.

Two of the major primary care specialties, specialties on which hopes for health care reform are often founded, have weighed in. ICD-10-CM will not help them care for patients. Instead, the switch would burden them unnecessarily and impede their ability to care for patients.