The governing board of the American Medical Association (AMA) has been considering a proposal that could save commercial health insurers tens of millions of dollars but slow insurers’ efforts to develop modern claims analysis and management strategies.
The proposal would affect what the U.S. health care system does about the current, outmodated diagnostic code system — the International Classification of Diseases, 9th Edition (ICD-9).
The body that runs the AMA, Chicago, is the AMA House of Delegates. The Georgia delegation at the AMA House is suggesting that the U.S. health care system might be able to avoid a world of ICD pain by ending the controversial struggle to shift to ICD-10 and move directly to adopt an edition that is supposed to come out in 2015, the 11th edition.
The World Health Organization (WHO) started work on ICD-9 in the 1970s, and it completed work on the next edition, the 10th in 1994.
Federal laws and regulations adopted before the Patient Protection and Affordable Care Act of 2010 (PPACA) came along originally were going to require the United States to shift to ICD-10 by Oct. 1, 2013. But the U.S. Department of Health and Human Services (HHS) now says it will push back the compliance date. HHS has not yet said what the new compliance date will be.
Health insurers care about ICD modernization because ICD codes are critical to health care and health insurance administration.
America’s Health Insurance Plans (AHIP), Washington, estimates a shift to ICD-10 will cost health plans about $11 to $38 per plan enrollee, or a total of about $3 billion industrywide.
Insurers complain about the cost and technical challenges of rushing to a new ICD standard while they have to deal with many other headaches, including a recession and PPACA. But insurers also have talked about the benefits of moving away from a diagnostic coding system developed nearly 40 years ago, at a time when medicine and health insurance were much different than they are today. Switching to modern codes could ease efforts to improve the quality of care and reduce the cost, advocates of the switch say.
The AMA’s Georgia delegation is calling for the AMA staff to evaluate preliminary versions of ICD-11 and report back to the House in June 2013 on the potential impact on a physician’s practice of shifting to the ICD-11 standard.
The AMA already has a policy in place that calls for the AMA to work to stop implementation of the ICD-10 standard. The AMA says current efforts to implement the standard impose “unnecessary and significant burdens on the practice of medicine.”
But AMA members have had mixed feelings about the ICD standard shift over the years, and the association also has a policy in place that calls for the AMA to develop systems to help physicians move to the ICD-10 standard.
The AMA is meeting in Chicago now. The ICD-11 resolution, Resolution 236, is likely to come up this week, according to a representative in the association’s press office.