Cardiologist/software developer discusses controversy surrounding ICD-10, 11 adoptions
Dr. Jon Elion
With the medical community relieved that HHS Secretary Kathleen Sebelius’ proposed rule to delay the compliance date for ICD-10 from Oct. 1, 2013, to Oct. 1, 2014, the inevitable changeover will occur – and needs to happen, said longtime cardiologist Jon Elion, CEO of ChartWise Medical Systems, developer of CDI software with ICD-9 to ICD-10 conversion capabilities.
“It’s time to change to ICD-10 because ICD-9 is very archaic,” said Elion, who earned a medical degree from Brown University, completed a residency at the University of Wisconsin-Madison, a cardiology fellowship at Duke, and spent six years at the University of Kentucky in Lexington before relocating to Rhode Island. “For example, ICD-9 has pages and pages of diagnoses for tuberculosis, and only one diagnosis for HIV.”
Elion pointed out that ICD-9 was released in 1993, and ICD-9-CM (clinical modification) was released a few years later.
“Few people understand that ICD-10 – the mortality reporting version; not the CM version – has been used in the United States since 1999,” he said. “Now we need ICD-10-CM to code at hospitals.”
Many industry watchers have wondered if it might be better to skip directly from ICD-9 to ICD-11, which is in the works.
“We’re fighting about whether to go to ICD-10-CM in the United States,” noted Elion. “It took a very long time – about 10 years – to develop the CM version because of some folks’ emotions and arguments, and frankly, misunderstandings. Technology development wasn’t a problem; it was politics and getting stubborn people to agree on the CM version. People say, well, it’ll take 10 years to develop the CM version of ICD-11. That speculation isn’t fair or accurate. Getting the ICD-11-CM version won’t take that long, nor will it be instantaneous.”
Elion called ICD-11 “wonderful.”
“I was so excited when I read it,” he said. “As a clinician, this is the way I practice medicine. It makes wonderful clinical sense because doctors worked on ICD-11, not just coding people and computer geeks and administrators.”
Elion emphasized there are “a couple of big howevers.”
“ICD-11 is many years away from its initial release,” he said. “Optimistically, I’d say 2015. More realistically, it’ll be a few years after that. It’s not going to take ICD-11 ten years to produce the CM version because ICD-11 is already very clinical.”
Elion emphasized a different wrinkle with ICD-11 that’s extremely important, and so far, unnoticed.
“When we came up with ICD-9, computers were in their infancy,” said Elion. “Very elemental programs were used. Several years ago, we were able to apply modern software technology and write our system so that it doesn’t matter if we’re using ICD-9, 10 or 11. Our software is ready for practices to plug in whichever coding system you want to use. For example, if you take it to Germany and plug it into their unique coding system, that’s fine. It’s possible to write computer software if you know what to anticipate coming down the road.”
The cost of transitioning from ICD-9 to ICD-10 has been a major concern to healthcare providers. In a letter dated May 16 to Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services (CMS), MGMA submitted comments on the proposed rule delaying the ICD-10 mandate for a year and implementing the use of a Health Plan Identifier. According to a 2008 assessment by MGMA and 11 other healthcare organizations concerning the financial impact the ICD-10 rule will have on providers, a small practice comprised of three physicians will pay $83,290; a large group of 100 physicians will pay nearly $3 million. The cost impact of the ICD-10 mandate in six key practice management areas: staff education and training, business practice analysis, changes to “superbills,” IT system changes, increased documentation costs, and cash flow disruption.
“Let’s remind ourselves of the costs estimated and incurred for Y2K; no one could ever prove the costs claimed,” said Elion, adding that when ICD-10 is referenced today, it’s actually ICD-10-CM. “A few years ago, I read somewhere that implementation of ICD-10 would cost the U.S. $14 billion. As far as I could tell, it was plucked out of thin air. If we’re talking about a physician’s outpatient practice v. a hospital, does he have personnel doing coding? Or does he use an outside company? I have a jaded eye to any of these estimates.”
Elion said it’s not clear the financial impact ICD-10 conversion will have on hospitals. “Sometimes, hospitals have very old software and they’re happy to keep it, but suddenly you find the software company is out of business or not supporting the conversion to ICD-10 and you have to buy brand new software,” he explained. “Also, what if you’re a doctor in a practice and you have electronic medical record software for office, and it’s running ICD-9, but the company doesn’t have an ICD-10 extension, or they’re going to charge several thousand dollars to convert to ICD-10, and you have to chunk it and go with another vendor? These are the costs that hospitals and physician practices need to study.”
Even though hospitals have been reviewing ICD-10 conversion for quite some time, recent statistics show sixty-something percent of hospitals believe they’re ICD-10 ready – a depressingly low number, said Elion.
“There’s a lesson to be learned for the medical software industry not to repeat the mistakes of ICD-9 software,” he said. “When writing ICD-10, be aware that ICD-11 is coming.”
Parenthetically, some physicians have misunderstood the American Medical Association’s stance on the looming conversion, Elion pointed out.
The World Health Organization (WHO) released International Statistical Classification of Diseases (ICD) and Related Problems as a way of tracking mortality statistics.
The National Center f or Health Statistics (NCHS), the federal agency responsible for use of the ICD and Related Health Problems, 10th revision (ICD-10) in the United States, has developed a clinical modification of the classification for morbidity purposes.
“People hear sound bites or read headlines saying they want to jump from ICD-9 to ICD-11,” he said. “What they’re saying instead is, ‘let’s study this. Are we going to be in a situation where we’ll go to ICD-10 and six months later, go to ICD-11?’ I’ll bet they’re going to find ICD-11 is sufficiently far enough ahead that it’s prudent to implement ICD-10.”
Studying the issue is very wise, noted Elion.
“I hope they get some computer-savvy medical people and some medical-savvy computer people together to put out a recommendation to vendors to be savvy about ICD-11, and make sure the software will make that transition more gracefully than it is from ICD-9 to ICD-10.”
As a cautionary note, Elion advises practice managers and physicians to be aware of mixed expressions – “ICD-10 ready” or “ICD-compatible” – that make it confusing to understand the nuts and bolts of upgrading to ICD-10.
“We built our software from the first day that’s not only ready for ICD-10, but also the coding system du jour,” he said. “It’s a more modern approach to software. I’m hopeful companies will take a more modern view to help design things better.”