Flawed Implementation of ICD-10 Less than Six Months Away

*Editor’s Note: The following is a special editorial from Dr. Jeff Terry, past president of the Medical Association, who has closely followed ICD-10 and testified before Congress concerning the need to delay implementation to mitigate the negative effects on medical practices.

Please don’t discount the cry for help coming from more than 90 percent of the physicians in this country. Please don’t overlook the obvious as far as what ICD-10 will really do to patient care, physicians’ practices and the medical profession. Please understand that 90 percent of the ICD-10 proponents will gain tremendously financially from ICD-10 implementation. Finally, please understand that ICD-10, along with all the other government mandates on medicine simply further removes the patient from the center of the health care equation and it gives physicians less time to listen to, talk to, and examine the patient. We are placing the computer in the middle of the patient-physician relationship where it doesn’t belong.

Physicians are scared. They are barely keeping up with the new electronic medical record system. Many physicians have to learn four or five different EMRs because they practice at different hospitals. We can’t use our own words anymore to describe our patient’s condition, our diagnosis and our plan. All of our comments, physical findings, orders and plans for care must fit into computer templates and other artificial ways to document. Part of the problem is trying to teach a generation of older physicians how to use the computer; another part of the problem is many different computer vendors that still haven’t figured out the right way to do it; and the final part of the problem is a meaningful use system which is anything but meaningful that forces us to do unnecessary work. Once a physician invests in an EMR he becomes a slave to that particular system because it is too expensive for most to make a change.

Physicians understand that coding is for statistics and has nothing to do with our patient care and is certainly not accurate enough to do medical research with, yet these are arguments that CMS and others use to convince Congress of the need for ICD-10. Also please understand the biggest untruth, which is that we are behind the rest of the world because no one else in the entire world has even come close to implementing an ICD-10 system like our government has proposed! Physicians are sending a very strong message that the present implementation of ICD-10 is extremely flawed and doesn’t make any sense. Physicians are sending a loud message that Congress/CMS must change the implementation of ICD-10 or many physicians will find themselves leaving the medical profession (willingly and unwillingly) and thousands of patients will be left without a doctor.

The best solution to this ICD-10 problem is to do what H.R. 1701 and S 972 from last year ask for: Delay ICD-10 and at the same time have a non-biased committee study the problem and come up with answers in the next six months. The study is needed because there are also many unintended consequences of this change that will also adversely affect the medical profession and patient care that CMS has not addressed yet. I understand the political reality, and CMS may not want to do this because the pro ICD-10 coalition is working so hard to the one-day implementation on 10/1/15. If this is not possible, then CMS must figure out a way to have a two-year transition period where physicians gradually transition into ICD-10 without having their payments go to zero for several months. Perhaps allowing a dual system for three to four months to start off and then accepting “generic” ICD-10 codes and not requiring the more specific codes for a couple of years.

Please see this non-biased article in Modern Healthcare from April 10, 2015. It points out the fact that many are not yet ready, and I testified to the Health Care Subcommittee of Energy and Commerce that no matter how much time you give us we will never be ready for a one-day implementation. It is like asking someone to run a four-minute mile or to fly an airplane all by yourself without real-time practice. It is not logical to think that our profession can do this. There must be a transition period. The industry may say that they are ready and 80 percent will be able to do it. What about the other 20 percent? Let’s assume only 5 percent of doctors don’t get it right. That means we lose 5 percent of our profession because of a coding system that will not actually help in the day to day care of our patients. These doctors will go out of business and for each physician we lose there will be 2,000 patients looking for a new doctor. This will happen in the district of every member of our Congress. Is this what America wants? We can do better!

Now that SGR is fixed, ICD-10 will be organized medicine’s top priority. ICD-10 must be urgently addressed because uncertainty is not fair to anyone, and the present plan for implementation will mean disaster for patients, physicians and the medical profession overall.

W. Jeff Terry, M.D.
Past President, Medical Association of the State of Alabama
Chair, Alabama Delegation to the American Medical Association
Legislative Affairs Committee, American Urological Association
Member, The National Physicians Council for Health Care Policy

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