Head-Scratching Time: AMA Says Waiting for ICD-11 a Bad Idea

The American Medical Association continues to oppose the migration to ICD-10, but it says waiting for ICD-11 and then switching will be worse.

The association released an analysis of ICD-11 that is full of contradictions and must have members wondering exactly in which direction the organization wants to proceed.

The federal government will require the healthcare industry to switch from ICD-9 to ICD-10 on Oct. 1, 2014. The AMA has opposed this switch, and until this new report, had thrown out the possibility that the government wait until ICD-11 is released sometime in 2015. That, however, is no longer the case.

“AMA harbors serious concerns and reservations with the significant burden of the ICD-10 mandate and will continue to convey these points to policymakers in Washington,” according to the new report by the organization. “However, given the even greater complexities and uncertainties with moving directly from ICD-9 to ICD-11, the Board of Trustees believes skipping ICD-10 and moving directly to ICD-11 is fraught with its own pitfalls and therefore, based on current information available, is not recommended.”

So is the AMA advocating that the federal government abandon the move to ICD-10 and ICD-11 and stay with ICD-9? Apparently not.

“ICD-9 is outdated today and continuing to use the outdated codes limits the ability to use diagnosis codes to advance the understanding of diseases and treatments, identify quality care, drive better treatments for populations of patients, and develop new payment delivery models,” according to the report.

So if the AMA has concluded that ICD-9 is outdated, but moving to ICD-10 will be too expensive to implement and switching to ICD-11 (skipping ICD-10) will be too difficult, what does it want its members to do? The advice appears to be “stay tuned.” The report concludes with the following statement: “The AMA will continue to advocate for physicians on this issue and monitor the situation as new information becomes available.”

Advantages and disadvantages

The report contains an excellent summary of the advantages and disadvantages of waiting for ICD-11:

The following are advantages for moving from ICD-9 to ICD-11 (skipping ICD-10):

• Implementation efforts for ICD-11 will be significant and costly regardless of whether or not ICD-10 is implemented.
• Waiting to implement ICD-11 will give physicians and the health care industry more time to implement electronic health records (EHRs) and develop the electronic systems infrastructure for health information exchange, since resources will not be stretched between the two major implementation activities of ICD-10 and EHRs.
• Physicians will only have to go through one implementation period, instead of two to go from ICD-9 to ICD-10 to ICD-11.

The following are disadvantages of moving from ICD-9 to ICD-11 (skipping ICD-10):

• ICD-9 is outdated today and continuing to use the outdated codes limits the ability to use diagnosis codes to advance the understanding of diseases and treatments, identify quality care, drive better treatments for populations of patients, and develop new payment delivery models.

• The market will miss out on the improvements in the ICD-10 codes that align with today’s diagnosis coding needs, including the addition of laterality, updated medical terminology, greater specificity of the information in a single code, and flexibility to add more codes.

• Skipping ICD-10 will impede the ability of the industry to build on their knowledge and experience of ICD-10, which is expected to be needed for ICD-11. Learning the medical concepts, training efforts, and overall implementation efforts for ICD-11 will be more challenging if ICD-10 is not implemented first.

• Focusing solely on moving from ICD-9 to ICD-11 risks missing the opportunity to educate physicians and leaving them unprepared for the anticipated transition to ICD-10, which could result in significant cash flow disruptions.

• Implementing ICD-10 is expected to reduce payers’ reliance on requesting additional information, known as “attachments”, which could reduce burdens on physicians, but this opportunity will be delayed until ICD-11 is implemented.

• The timeframe to have ICD-11 fully implemented could be as many as 20 years, unless there is a strong commitment by the industry to implement it faster.