Doctors spending on EMRs instead of ICD-10-CM switch

As I noted in a previous post, doctors have insufficient resources to both adopt electronic medical records and switch to ICD-10-CM.

As this story indicates, doctors have been focusing resources on meeting the federal government's "meaningful use" criteria for EMRs at the expense of the switch to ICD-10-CM. Specifically, two thirds of physicians responding to a survey reported spending resources on "meaningful use" in favor of ICD-10-CM.

Of course, in my post, I said that the switch would slow down meeting "meaningful use", but it appears that the converse is happening, and that "meaningful use" is slowing down the switch.

Regardless, the switch ought to be deferred to allow physicians to meet "meaningful use".

Family physicians seek ICD-10-CM delay in testimony to Congress

On July 27, in testimony (warning: PDF) to the House Energy and Commerce Subcommittee on Health titled "Regarding Implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act", Dr. Roland A. Goertz said that implementation of electronic medical records ought to take precedence over the switch to ICD-10-CM.

Dr. Goertz said "...practices are at their maximum capacities for change, and we ask that your committee not make additional requests of these physicians during this transition and even look at the required adoption of ICD-10 as something to delay."

Story on ICD-10 contains inaccuracies

A story about 3M consulting services to assist hospitals with the transition to ICD-10 contains several gross inaccuracies.

First, it mentions "ICD-10 concepts and terms". ICD-10 does not have concepts and terms, nor does its predecessor ICD-9-CM. It has codes, categories, and titles. The use of the phrase "concepts and terms" is highly misleading as it suggests that ICD-10 is a concept-based terminology. Although I have issues with those as well, they are lightyears of ahead of ICD-10's archaic structure. So the implication is that ICD-10 is something much better than it really is.

Second, the story lists 4 purposes for ICD-coding of diagnosis, and lists the single most important one, reimbursement, last. Were it not for reimbursement and bureaucratic requirements, no one would assign ICD codes for clinical care, quality, or epidemiological purposes.

In summary, this article misleadingly paints a much more favorable picture of ICD-10 than is warranted by the facts.

ICD-10-CM is NOT a nomenclature

In this article about the lengths to which organizations must go to 'upgrade' to ICD-10-CM, the author refers to ICD-10-CM as a 'nomenclature'.

ICD-10-CM, as its formal name indicates, is a classification, not a nomenclature. Its formal name is the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), as listed on the web site of the government agency that created it from ICD-10.

For example, ICD-10-CM code K83.8 refers to Other specified diseases of the biliary tract. This class of diseases includes multiple individual diseases such as: adhesions of biliary tract, atrophy of biliary tract, hypertrophy of biliary tract, and ulcer of biliary tract.

A nomenclature, by contrast, would have codes for each of these diseases that ICD-10-CM lumps together under the single code K83.8.

So, unfortunately, misinformation about ICD-10-CM continues. Were it truly a nomenclature, and a good one, then it would truly be a worthwhile upgrade.

ICD-10-CM Winners

The Workgroup for Electronic Data Interchange or WEDI announced the release of its ICD-10 Vendor Resource Directory on Feb 11, 2010.

The companies all listed here stand to benefit financially from the switch to ICD-10-CM, and thus we dub them the "ICD-10-CM winners".

The losers, of course, are your doctor, your hospital, and your health insurance company (if you have one), just for a start. The switch will cost them money.

ICD-10-CM and Windows ME: A Switching Analogy

Much of the lack of resistance to the switch to ICD-10-CM is based on the presumption that since it is the next "version", it simply must be better. Proponents deride the arguments against the switch as being analogous to the question "MS-DOS works fine, why Windows?"

However, a better operating-system analogy would be "Windows 98 works fine, why Windows ME?"

As those who upgraded to Windows ME can attest, the upgrade was a complete disaster. PC World rated Windows ME as the fourth worst tech product of all time.

Analogously, ICD-10-CM is the last upgrade for the archaic, "statistical classification" architecture of terminologies. ICD-11 will use modern approaches to terminology.

In this sense ICD-10-CM is very much like Windows ME, in that Windows ME was the last MS-DOS based Microsoft OS before Microsoft converted its home OS to the newer, Windows NT architecture.

How ironic.

As naysayers against ICD-10-CM, we are saying that we should skip ICD-10-CM, which is the Windows ME of disease classification. It is the proponents of ICD-10-CM who are arguing for the perpetuation of ancient technology, not the naysayers.

The cost of the switch, briefly revisited

Prior efforts to estimate of the cost of switching from ICD-9-CM to ICD-10-CM compared the cost to that of Y2K remediation. In a post last year, we also highlighted the comparison.

The American Hospital Association estimates that the cost of Y2K was $8 billion for hospitals. Compare that to the Health and Human Services (HHS) estimate for switching to ICD-10-CM of $1.6 billion.

Now comes the experience of someone who lived through Y2K and now is preparing his hospital for the government-mandated switch.

Stanley Padfield, system director for health information management at four-hospital Lee Memorial Health System, Cape Coral, Fla, considers the cost of the switch to be higher than that of Y2K remediation.

An article describing Padfield's experience notes:

Padfield says tackling the ICD-10 challenge will prove more difficult than Y2K “because there are a lot more variables involved.” Plus, providers that fail to adequately prepare risk not getting paid promptly by Medicare and other payers.

So, the early experience is already that the ICD-10-CM switch will cost hospitals more than the $8 billion they spent on Y2K. Which dwarfs the HHS low-ball figure of $1.6 billion for the entire health care system to switch.

Even the optimistic RAND report that analyzed the cost of the switch could not come up with more than $7.7 billion in benefits to the switch.

So the early signs are that the costs of the ICD-10-CM switch to the health care system will far exceed the benefits.