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AMA thinking seriously about ICD-11

ICD-10 proponents are not going to like this one bit.

Certainly not any more than they enjoyed my suggestion that the proposed ICD-10 deadline extension puts the U.S. healthcare industry into a strange time warp in which providers and payers will be finally implementing ICD-10 in the same one or two-year timeframe that ICD-11 is entering this world – and that being the case perhaps holding out for the 21st Century classification system that will be ICD-11, then moving aggressively to that is, well, at least worth considering.

Here it comes: The American Medical Association late Tuesday took up the ICD-11 cause.

Until now, it was a soft chant by rather disparate voices. If recent history with the proposed ICD-10 delay is any indication, though, the AMA can bellow loud enough to be heard in the highest of strongholds.

Potential alternative
The AMA voted on Tuesday to evaluate ICD-11 as a possible alternative to ICD-10 for replacing ICD-9 – saying that it will report back to delegates in 2013 with its findings.

“It is critical to evaluate alternatives to ICD-9 that will make for a less cumbersome transition and allow physicians to focus on their primary priority – patient care,” AMA president-elect Ardis Dee Hoven, MD, said in a statement. “The policy also asks stakeholders, such as the Centers for Medicare and Medicaid Services, to examine other options.”

Practicing the ‘it can’t hurt to ask’ methodology ostensibly worked for the AMA in getting ICD-10 delayed earlier this year. Two unrelated anonymous sources, both well-positioned vis a vis ICD-10, told me separately that even HHS Secretary Kathleen Sebelius was surprised when word came down – from the White House? – that her department was to postpone code set compliance. Take that as an unconfirmed rumor, please. But know that somebody, somewhere made the delay happen.

[See also: ICD-10 deadline do-over?.]

To be fair, the AMA could be in a time dimension all its own. HHS is likely to decide whether October 1, 2014 will be the new deadline, or not, well before 2013. Let’s hope. Unless HHS pushes ICD-10 further into the future, the AMA may be too late to start calling for ICD-11.

But the WHO in mid-May posted what it calls the beta drafting platform of ICD-11 – meaning work is underway though the process is undeniably nascent.

Not alone
The AMA is not the only one chanting for ICD-11. In a blind reader poll, Government Health IT asked its readers ‘Should the U.S. leapfrog ICD-10 and opt for ICD-11?

Nearly one-quarter indicated “yes” while one-third weighed in with a firm “no.” Given the circumstances, which include the fact that ICD-11 is not yet ready for primetime, the more telling perspective is the 43 percent of a total 115 respondents who voted that “it’s worth considering.”

Matt Murray, MD, a pediatric emergency physician and self-described health IT advocate, contends in a May 17 blog post that CMS “prematurely dismisses the alternative option to forgo ICD-10 and implement ICD-11,” adding that he is “very concerned that this dismissal is published without a comparative analysis of the total costs of each option. And there is good reason to seriously consider implementing ICD-11.”

That’s a point very similar to one the MGMA has made – that before mandating ICD-10, CMS should conduct a comprehensive cost-benefit analysis, pilot ICD-10, and fully evaluate alternative approaches. Sounds only reasonable to me.

“Implementing ICD-10 has been compared to buying a Betamax instead of a VHS recorder in terms of pending obsolescence,” Dr. Murray wrote. “Informatics experts are in agreement that ICD-11 is superior to ICD-10 and that we need to get to it as soon as is tolerable.”

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