A large-scale overhaul in the health care industry is causing major headaches for physicians ahead of its implementation date this fall.
Doctors across the country could lose significant amounts of revenue - enough to affect their ability to care for patients, critics say - as a result of a mandatory update of the United States' health care codes to the International Classification of Diseases, 10th edition, or ICD-10.
"It's very complicated, and I'm afraid it's going to be a disaster," said Jim Wring, practice administrator at Purchase ENT in Paducah.
Starting Oct. 1, every doctor, hospital, insurance company and clearinghouse must change from the ICD-9 to the ICD-10 coding system, increasing the number of diagnosis codes physicians use from around 13,000 to nearly 70,000.
The transition to ICD-10 will be costly, but if doctors don't make the switch, they won't receive reimbursement for their services. Purchase ENT's three-physician practice, for example, faces costs of up to $84,000 in lost productivity, employee training, and systems upgrades related to the update, Wring said.
He added that practices have been advised to keep anywhere from three to six months' worth of revenue in reserve to weather a change that many don't see as necessary.
"There's not a change in the different sicknesses and illnesses people have, but to be able to get paid for the services we provide, we have to make our coding a lot more specific," he said. "It brings absolutely no value to the quality of medicine."
In fact, he believes it could hamper care by restricting the number of patients an office can treat.
"If income stops coming in, what's the physician's office going to do?" he asked. "If we're not getting paid for what we're doing, it's going to limit (patient) access."
Dr. Christopher Sperry, a family practitioner with Mercy Primary Care, said he expects patients to experience longer visits after ICD-10 goes into effect, as more detailed documentation requires more time. But he says there are benefits to the switch.
"It's becoming more descriptive," he said of the diagnosis codes. "(ICD-10) improves physician-to-physician communication, as long as it's documented correctly."
Lisa Asbell, CEO of TrainRx.net, a company designed to help with the transition to ICD-10, said there are other upsides to the new coding system.
"ICD-10 is going to make it more feasible to ... continue on the quest to an e-health environment. It's proven in other countries that have made the transition to be better for reimbursement providers and to limit the number of denied claims. It also makes for better patient care by collecting better patient information," Asbell said.
She called it the biggest change in health care in 30 years, and said it will affect every process doctors and office staff have to go through. Even receptionists, schedulers and doctor's assistants will have to change the way they talk with patients, asking new and more specific questions.
"Everything changes in the practice," she said. "I really feel for private practice over this. Even though I can see some benefits of ICD-10, I personally see that it is difficult."
Over the years, ICD-10 has met with resistance from organizations such as the American Medical Association, which for more than a decade has asked that implementation be delayed or set aside. In a Feb. 12 letter to U.S. Health Secretary Kathleen Sebelius, the AMA called ICD-10 a costly, unfunded mandate that will not improve patient care and urged the centers for Medicare & Medicaid Services to reconsider it.
"We are concerned that payers will place strict requirements on the specificity of the codes reported and reject or pend claims, further compounding payment disruptions for physicians," the letter read.
"I'm not necessarily for ICD-10 moving forward, but it is, and we have to quit pretending and get busy," Asbell said.
Contact Laurel Black, a Paducah Sun staff writer, at 270-575-8641, or follow @LaurelFBlack on Twitter.