Why politicians won't care about ICD-10 implementation

Carl Natale
by Carl Natale

There will not be a strong debate over ICD-10-CM/PCS in Washington.

I know the American Medical Association sent a letter to U.S. Rep. John Boehner, Speaker of the House of Representatives, that explained why ICD-10 implementation should not happen. But that isn't going to mean anything.

There is going to be a nasty, all-consuming debate over Obamacare. Government Health IT editor Tom Sullivan explains how politics distorts the healthcare reform debate. Basically, anything favored by this administration is framed as socialized medicine by conservative elements. And ICD-10 implementation will be seen as a bureaucratic piece of Obamacare.

Correction. It already is seen as part of Obamacare.

Consider The Hill's balanced and accurate reporting on the AMA letter. It doesn't mention Obamacare. But it doesn't take long for the comments to devolve into partisan bickering. My favorite is this comment:

"Then it wouldn't be the blame of Boehner for the change in codes for illnessess, it would the fault of Obamacare requiring this large and expensive change so quickly as it is extremely costly and time consuming to do.  68,000 versus 13,000 is a very large difference. "

Which came after Steve Sisko tried to inject some reality into the debate. It didn't matter. No one let the facts get in the way of criticizing Obama.

But here's the thing. The commenters may be more right than they realize. Consider what John D. Halamka has to say about ICD-10 implementation. He's not a fan, but he is the Chief Information Officer of Beth Israel Deaconess Medical Center and Harvard Medical School. And he knows this has to happen. In a very logical and thoughtful way, he explains he wants to delay ICD-10 implementation. But that's not going to happen because, "I've been told that the Affordable Care Act (ACA) includes cost savings from reduction in healthcare costs/fraud/abuse that require the implementation of ICD10. Thus, it's not likely going to be delayed."

When he writes about the ACA, he's referencing the Patient Protection and Affordable Care Act that passed two years ago. It's also affectionately known as Obamacare. Although the ACA doesn't really addresss ICD-10 (except for a timetable for crosswalks but that's it), it does set up accountable care organizations (ACOs). The ACOs are networks of healthcare providers who will get financial incentives to deliver quality care instead of services. So if patients are better off due to the care they receive, there are financial rewards. This is supposed to lower costs overall because it supposedly will remove incentives to deliver unnecessary procedures and tests.

And to measure and track all this, ACOs are going to need a way to report data. Reporting is a big part of the ACO legislation. Electronic health records, (EHRs) and health information exchanges (HIEs) will be essential. So will medical codes. Very specific medical codes.

This means that there is the belief that ACOs, EHRs and HIEs aren't going to change anything unless there is a change in the data being collected and transmitted. Are the ICD-10 opponents going to argue that healthcare reform doesn't need granularity? Or are they arguing that physicians need financial incentives to make it all happen?
Neither. Those arguments won't matter. What will matter is the louder debate over healthcare reform. ICD-10 is tied to it and will be collateral damage if the ACA is repealed. I really can't see a Republican controlled Congress that wants to kill Obamacare but wants to pay for Meaningful Use and ACO incentives. Then the AMA is going to have to draft another vigorous letter.