What do ICD-10, doc fix have in common? Nothing good

3:18 pm by | 3 Comments

The government is remarkably good at kicking cans down the road.

This is the single reason is why government-run health care costs so much.

For instance, we continue to kick the can down the road for the doctor pay fix. Time and time again, we see the Sustained Growth Rate formula fail to be overturned, and instead, Congress vote a few-month reprieve to pay cuts for doctors until they can find another way to either pay those who do the work, or cloak these pay cuts in another, less visible and acutely painful way. Look, we all know it’s coming: paying a few paultry percent more for primary care while slashing specialists payments 40% was lost on no one.

And now their kicking the ridiculously complex and overly obsessive medical coding scheme called ICD-10 down the road. Recently we hear the purveyors of this money making scheme, the AMA along with their co-dependents at the Health and Human Services claim they will:


“announce a new compliance date moving forward,” the agency says.

“We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” HHS says.

As if they really care. Better yet, it’s as if doctors were on really okay with this coding scheme, but just a little “administratively burdened.”


Let me clear: doctors are NOT okay with ICD-10. We never have been. Nor will we ever be. It provides NO value to the patient experience. And let me be even clearer: the REAL reason this can is being kicked down the road is because there are not enough programmers in the world capable of debugging and writing the mounds of computer code accross the scores of information systems out there in the time allotted, nor personnel capable of training all the medical coders and the various permutations of “medical providers” out there on how to use this system.

The delay in implementation of ICD-10 and the inherent costs associated with its implementation and delay of implementation has NOTHING to do with doctors.

Yet this coding scheme and bureaucratic delays of things like the doctor pay fix and the implementation of ICD-10 has EVERYTHING to do with how expensive our health care system has become and how expensive government health care is in general. But you will never see the huge costs of all these delays and hand-wringing accounted for in a non-partisan budget office.

Yep, the reality of these inefficiencies within government-run processes are the poster children for why our entire US health care system is so expensive.

Copyright 2015 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Westby G. Fisher, MD

By Westby G. Fisher, MD

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005. He writes regularly at Dr. Wes. DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.
Visit website | More posts by Author

Don Seamons
Don Seamons

As a healthcare consumer, and as one who must follow the ins and outs of healthcare administration for a living, I can see where ICD-10 would benefit me, my family, my friends and neighbors. The key is better data. Give docs, hospitals, health plans better data, and it's easier to find outliers and best practices, which can improve care and drive down costs. Give consumers better data, and it's easier for us to choose the best physicians. ICD-10 is a key to better health data. If I'm seeing things too simplistically, let me know. I'd like to understand why. Also, ICD-9 is outdated and soon to be unusable, since the code structure can't accommodate many more diagnoses and procedures. If doctors will never be supportive of ICD-10, what's your alternative?


"...ICD-10 is used in every developed country in the world except the United States" So what. The question is are the benefits of ICD-10 worth any focus on it right now in the United States. Canada adopted it over 10 years ago. The time and expense to their system could have been better used to improve their patient care.

Mike Arrigo
Mike Arrigo

I agree with Dr. Fisher's comments about inefficiencies of government, and the poor track record in their ability to impact favorable change in healthcare. But the time to debate ICD-10 was in 2008. The CMS mandate for ICD-10 went out August 15, 2008. We didn't hear from physicians groups (the AMA or other) then. ICD-10 is used in every developed country in the world except the United States. The fact that we have aging, overly complex HIT systems with an underlying, decades old coding standard (ICD-9) isn't a reason to block an improved way of coding diagnosis and procedure codes. Rather, we should look at the fact that many of the Health IT infrastructure vendors aren't very good at supporting interoperability and flexibility in their systems. Having worked in financial services which has survived many regulatory changes, Healthcare is by comparison so much less flexible in its systems. In the end, flexible evolving systems will have to be developed to support better health care. ICD-10 isn't the culprit, it is a change in standards that at some point will have to be supported, even if we move to ICD-X ICD-11, or ICD-100 there will be change in health care systems, diagnosis and procedure codes. Kicking the can down the road now on ICD-10 is penalizing the payers and providers who have invested $100s of millions to comply with the CMS mandate. Granted many (perhaps the majority?) of hospitals need an extension, but will they use the extra time toward making a new compliance date or let this extra run way get away from them again? There is no question that hospitals have many administrative burdens today. But the answer isn't to avoid modernization. The human body is itself an evolving system. Health IT and the standards for it must be as well.