Star-crossed health IT projects, ICD-10 and meaningful use are inextricably linked. But is one in the way of the other?

That’s the assertion of Peter Muir, of the Springfield Center Family Medicine in Springfield, Ohio, one of the first to attest to meaningful use and receive federal reimbursements. Muir spoke with Government Health IT Editor Tom Sullivan about how meaningful use is making ICD-10 even more complicated.

Q: How do you balance ICD-10 and meaningful use?
A: If it wasn’t for meaningful use I’d already have ICD-10 built in with a crosslink to both ICD-9 and ICD-10 codes on the patient. But because of meaningful use we’re migrating to the common standard and being very compliant, which means now I cannot modify my templates as much. When it comes to ICD-10, that’s going to be built into a lot of the templates.

Q: Is meaningful use holding up ICD-10?
A: Well, I would have done ICD-10 first. We’re doing a lot of change right now, but in two years we’re going to change again for ICD-10. It’s kind of like getting everybody together at the table, then taking one leg off each chair. What would be really helpful is for docs to be able to run the stuff in parallel so we could gently be modifying our charts instead of having to learn ICD-10 and modify all our templates in very short order. So if I see a diabetic patient already coded in ICD-9, wouldn’t it be nice if I could run in parallel and also have the ICD-10 code in there so over the next year or two my codes would gradually transition over? I’d have done ICD-10, and then I would have done meaningful use, rather than the chair leg when everybody’s already sitting at the table. That would make life easier on a practice.

Q: Given that the MGMA estimates ICD-10 will cost $84,000 for a small physician practice, do you anticipate ROI?
A: There won’t be an ROI. It will be an LOI – a loss on investment. Let me use an analogy: When I was in Canada I wrote a billing system that we used for seven years. This was in 1983 before the IBM PC came out. In 1989 the Ontario government decided to change from an eight-digit billing number to a 10-digit billing number. The government then basically said you guys are all going to have to buy new systems, and I had a choice of redoing my system from scratch because I really didn’t anticipate they would change that number, or switching to a new system, which I did. The Ontario government then sent out application forms for people to register and get a new number. Within four months of them doing that and costing every doctor in the province an immense amount of money and time, there were more individual numbers on the new system than there were on the old. Patients could sign up their dog, their cat.

Q: Were there advantages to the new system, such as ICD-10’s greater specificity?
A: I think ICD-10 is not going to help physicians in the practice of patient care. ICD-10 is still not the ideal system. For example, on malignancies it gives an anatomical diagnosis by the patient as opposed to the staging, so it doesn’t really help. I don’t think ICD-10 is going to have a positive impact, it’s going to have a negative impact on healthcare, costing a lot of money and not really improving care at a time that we are also going to be having a lot more patients coming into the system and doctors will be a lot more pressured. My prediction is there will be a wave of doctors approaching retirement age who retire earlier rather than later.

Q: I have heard that from a number of different people. …
A: If there’s one more hurdle you have to jump and you’re running to the end of the race and the refreshment stand is over to the left, maybe you’re just not going to take that last turn. 

[Related: The top 4 jobs ICD-10 will place in high-demand. See also: ICD-10 Putting Americans back to work, the talent dearth.]