Foot soldiers
The imminent war over ICD-10 will be fought between those who stand to profit in the near-term and those who represent the folks that will have to finance and implement ICD-10. And while it may be fought by the association generals, there are a host of tech vendors, coding service providers, foot soldiers, if you will, also taking up the fight.

Nick Dobrzelecki, CEO of Daymarck, a home healthcare coding specialist, breaks ICD-10 costs into three categories: training, productivity losses, and system changes.

“Any healthcare facility, such as a hospital, private practice, or home health care agency would incur costs for training, productivity losses and system changes,” Dobrzelecki says. “Because the elderly population continues to grow and therefore more healthcare professionals enter the field, delaying implementation will only increase these costs.”

Wellpoint vice president Andy Mader last week submitted a comment letter to HHS asking the agency to remove the .3 percent cap on ICD-10 within the Medical Loss Ratio provisions. Such a move would enable payers to treat the conversion as a quality improvement, rather than an administrative cost, a shift that would enable payers to include associated costs for changing medical office procedures, updating billing, administration and other relevant systems under the 80 or 85 percent of revenue they are required to spend under PPACA. “Pushing back deadlines would also help,” Mader added.

Unless, that is, ICD-10 is somehow blocked altogether, but it’s highly unlikely the AMA alone can accomplish that.

A trail all-too-familiar
Deborah Grider, senior manager of revenue cycle at accounting firm Blue and Co. and formerly the AAPC president and CEO, and an author of AMA-published ICD-10 books was having dinner with her editors at the AMA when news of the letter to Speaker Boehner came out.

“So we did talk about it and everybody is sitting on pins and needles waiting for something to happen, but the problem is every meeting I go to, every group I get in front of – I was at the Kentucky Medical Society a couple days ago speaking to a group of physicians – they bring up the letter, saying they feel the AMA is going to get ICD-10 stopped,” Grider explained. “My fear is that people are going to now lag behind and just sit and wait and it’s going to be late. In fact, AHIMA just came out with an article asking people not to wait and, you know, we’re out there in the industry trying to encourage them to get ready.”

Which is not to say that Blue has joined with AHIMA in any kind of official capacity, but lest the idea of allied industry associations seem far-fetched, Grider reminds that before ICD-10 was delayed until October 1, 2013, and during her time at the AAPC, “We banded together with others to try and delay ICD-10. Part of it was successful, we did get an additional couple years to implement. But I don’t think it will be pushed back much. If we are delayed, it will probably be 3-6 months and no more. If it’s 3-6 months and no more, well, there’s your breathing room right there.”

Given that ICD-10 has been postponed before, why the calls for either delaying it again or eliminating it altogether?

Perhaps because, even since the last deferment, very little has been done to gauge whether physicians actually can manage the transition in terms of cost, time, and resources.