Doctors: Regulatory burden crowds out health care reform

In a letter to Donald Berwick, MD, Administrator of the Centers for Medicare and Medicaid Services, the American Medical Association lists the regulations that have been and continue to be most burdensome to physicians.

I will let the letter speak for itself (emphasis exactly as in original). Note that ACA = Affordable Care Act, the major healthcare reform bill enacted into law in 2010.

The human and technological investments needed to participate in quality incentives are competing for physician time and resources needed to move to an enormous new set of diagnosis codes in ICD-10. The struggle to keep up leaves little time to get engaged in the practice redesign and payment and delivery reforms envisioned in the ACA and detracts from patient care just as the ACA is promising access to millions of uninsured Americans. We strongly urge the Administration and CMS to carefully consider the impact the collision of these compliance deadlines will have on physicians, patients and the ACA’s promise of better care for more people.

The Breathtaking Scope of ICD-10-CM Revisions for 2011

The Centers for Medicare and Medicaid Services just released a 2011 version of ICD-10-CM. A quick look at the "ICD-10-CM 2010 to 2011 Addenda" reveals a breathtaking scope of change.

First, the "Addenda" document (misnamed, since it also includes things removed and edited, not just added) for the tabular index totals 185 pages in a file nearly 1MB in size. Second, the changes span every chapter of ICD-10-CM.

Worse still, is that numerous codes have undergone a change in meaning, something decried by experts in medical informatics over 16 years ago.

Here is an example:

C64.1 Malignant neoplasm of right kidney, except renal pelvis

is now:

C64.1 Malignant neoplasm of left kidney, except renal pelvis

The update also deletes codes, which also militates against best practices in medical terminology management. Deleted codes include C64.0, C65.0, C66.0.

Anyone trying to update software applications that take advantage of particular codes for logic-based processing will surely have to review all 185 pages very carefully to esnure that their logic remains consistent. DRGs will have to be reviewed as well.

These substantial changes just 1.5 years prior to the deadline to switch will increase the cost and complexity of the switch. Another unwelcome development in the long, sad saga of ICD-10-CM.

Absurd arguments for ICD-10-CM

Sometimes, the arguments in favor of ICD-10-CM border on the absurd. In the January, 2011 issue of Healthcare IT News, the increased "specificity" of ICD-10-CM is highlighted as improving cost savings and disease management. What evidence are we given? The following list of codes:

I'm sure that there are hundreds of billions of dollars to be saved in the health care system, now that we can only code dolphin and sea lion bites better.

Dr. Joel Diamond, in his Health Interoperability Blog, documents similarly absurd arguments here. One proponent of ICD-10-CM said we'd be better off because we would be able to document not just "sports injury", but also whether the injured party was struck by a basketball, baseball, or football.

Busy clinicians trying to take care of sick patients are the ones we will rely on to code this additional specificity, however. Do we really want to distract them from patient care to find the code for dolphin vs. sea lion bites, or strikings by basketball vs. baseball? Is this really the best use of six-figure talent?