ICD-1May Push More Physicians from Private Practice on Louisiana Medical News

ICD-1May Push More Physicians from Private Practice

By: TED GRIGGS

Adding ICD-10 codes to federal health reforms, electronic health records requirements and lower reimbursements may be the proverbial last straw for small physician practices, according to some industry members.

“Candidly, the way that things are going in healthcare, particularly in small and rural practices, this just may be the straw that breaks the camel’s back,” said Dr. Patrick Breaux, a New Orleans cardiologist. “I think this is a huge unfunded mandate that’s going to cost private practice just huge amounts of money to implement.”

Breaux, president of the Louisiana State Medical Society, said he can’t speak for the group because the society has not taken an official stand on the new International Classification of Diseases coding.

However, the ICD-10 codes will require doctors to invest even more money in electronic health records and health information technology, and add to the cost of maintaining those systems, Breaux said. In addition, practices will have to pay for the additional training required for the personnel who will be doing the coding.

The current ICD-9 system has around 17,000 codes. ICD-10 has nine times that amount, or roughly 155,000 codes for tests, procedures and diagnoses.

The federal Centers for Medicare & Medicaid services estimate it will take from 18 months to 36 months for providers to make the move to ICD-10.

Both the Medical Group Management Association, which represents administrators and group practices, and the American College of Physicians, which represents more than 130,000 doctors, oppose the current implementation date: Oct. 1, 2013, Breaux said.

The MGMA estimates the cost for a three-physician practice to adopt ICD-10 at around $85,000. The cost to move the same practice to an electronic health record is $99,000.

“By complying with ICD-10 adoption, most medical groups will not be able to afford an EHR,” according to the MGMA.

However, supporters, including CMS, claim the new coding system will lead to improved patient care because ICD-10 will do a better job of measuring the quality, safety and effectiveness of treatment.

ICD-9, critics say, is running out of codes, and providers are limping along under an antiquated system.

The new codes will aid in designing payment systems and processing claims for reimbursement, according to CMS.

Other advantages of more specific coding include better epidemiological tracking and studies, according to CMS, as well as improved clinical, financial and administrative performance.

For those and other reasons, the American Hospital Association has long supported the move to ICD-10. The association called the shift essential in 2003.

And a 2004 report by Rand Science and Technology Policy Institute estimated hospitals would benefit from more accurate payments for new procedures by an estimated $100 million to $1.2 billion.

John Matessino, president and chief executive officer of the Louisiana Hospital Association, said converting to ICD-10 will be a big expense for hospitals, but he is not sure anyone knows what the exact cost will be.

The move to ICD-10 is just one of the many large issues hospitals and healthcare providers are dealing with right now, Matessino said.

When he goes to Washington, D.C., for meetings on national healthcare reform, there’s a lot of talk about different topics, Matessino said. The LSMS says that’s all very nice, but member hospitals are more concerned with surviving until the healthcare reforms are enacted.

“In Louisiana right now, we’re just trying to keep doors open on some of these hospitals and make sure that really critical services don’t get closed or cut back as a result of … the budget cuts at the state right now,” Matessino said.

The state budget picture looks pretty grim for the next two years, he said. Piling ICD-10 on top of all the stuff that’s going on with national healthcare reform and electronic health records is just one more challenge.

Matessino said he doesn’t think most people understand all the changes that take place every year in the ICD-9 program to diagnostic-related groups – there are around 500 for hospital cases – and the groupers that assign those diagnoses.

“Trying to take different DRGs and match them to a whole new coding system …. I have a feeling it’s going to be a zoo,” Matessino said.

And the move is coming at a time when hospitals, no matter what part of the country they’re in, are “stressed pretty much to the max,” Matessino said.

Breaux said the ICD-10 requirements may accelerate the trend of doctors moving from private practice to hospital employment.

In large measure, that trend is driven by the fact that physicians can no longer keep up with the complexity and expense of running a small business and practicing medicine in the current business environment, Breaux said.

The ICD-10 codes aren’t going to help with that, and the new coding system won’t increase reimbursements for doctors either, Breaux said.

“It is going to be an unmitigated nightmare,” Breaux said.