Mar 14, 2014

Is it wise to adopt the DSM-5?

The American Medical Association is facing a similar question with the ICD-10 (International Classification of Diseases, 10th edition). It has taken a bold step, opposing the new diagnostic scheme. This news should interest everyone in the mental health field. The two, ICD-10 and DSM-5 are closely intertwined. If one goes, so would the other.

I got this news about the AMA’s opposition last month from Ken Pope, and held onto it to see. What would other professions do? This is incredibly important, but, sadly, I have heard nothing from The American Psychological Association, the NASW, AAMFT . . . What about all of us affected by the upcoming DSM 5?

This is vital for you to know about and respond to, because if Sebelius does toss aside the ICD-10, the DSM-5 also goes to the side of the road.

What do we gain from the DSM-5? I argue that we gain nothing at all. It is a document more oriented toward medicating behavior. The problem for us is that we non-medical therapists might be able to have more positive impact on those behaviors than medicine would have. I suspect the DSM-5 will have some negative unintended consequences. Medicalizing means more of what has already happened. People strongly prefer medication to psychotherapy, even though we know therapy has some strong advantages. What we lack is the huge advertising budgets that the drug houses use to push their “solutions.” The DSM-5 is not a safe tool for us to adopt.

In the STAR-D trials, the idea was to vary whether people received antidepressants or psychotherapy, but the problem was that patients did not want the psychotherapy. They wanted medication. The drug houses have convinced (should I say, “brainwashed”?) Americans that drugs are the pathway to mental health.

The problem is, for anyone in the mental health field, drugs are over-rated. They are somewhat helpful, but without psychotherapy, the underlying problem remains unaddressed.

So take a look at what Ken is reporting. You can read the whole letter through is a link below Ken’s synopsis. I am quite impressed with the AMA’s arguments.

Also, bear in mind that both Robert Spitzer and Alan Francis have strongly criticized the DSM-5. Spitzer chaired the DSM III committee, and Francis chaired the DSM IV. What does that say when they both oppose it?

I don’t know what our organizations are doing. I have to confess I grew tired of the APA and quit it a few years ago. So they won’t listen to me. But I know some of you are true and faithful to your professional organizations  (bless you!) and you ought to be asking their position when it comes to the ICD-10 and DSM-5.

Take careful note of the quote Ken choses to use at the bottom of his report!

Here’s the report:

Wednesday, Feb 12, James Madara, M.D., the Executive Vice-President of the American Medical Association, sent a 7-page letter to Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services.

Here’s how the letter begins: “On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing to you concerning ICD-10. Regardless of any informational reports or material posted on our website that discuss the feasibility of ICD-10 or ICD-11, AMA policy adopted by our House of Delegates calls for repealing ICD-10 for the simple reason that it is not expected to improve the care physicians provide their patients and, in fact, could disrupt efforts to transition to new delivery models.”

Another excerpt: “By itself, the implementation of ICD-10 is a massive undertaking. Yet, physicians are being asked to assume this burdensome requirement at the same time that they are being required to adopt new technology, re-engineer workflow, and reform the way they deliver care; all of which are interfering with their ability to care for patients and make investments to improve quality.”

Another excerpt: “Many practicing physicians regard ICD-10 as a costly, unfunded mandate that will not improve patient care.”

Another excerpt: “According to a new report by Nachimson Advisors, the estimated price for a small practice to meet ICD-10 requirements will range from $56,639 to $226,105.  In comparison, the 2008 estimated cost for a small practice was approximately $83,290.”

Another excerpt: “The AMA is committed to repealing the Medicare Sustainable Growth Rate (SGR) formula and helping physicians transition to innovative health care delivery and payment systems.  Physicians’ ability to purchase technology and participate in new payment and delivery reform models that improve care coordination and reduce costs will be stifled if their resources are diverted away in order to meet ICD-10.”

Another excerpt: “Our experience with HIPAA mandates is that there are always unforeseen obstacles. The AMA is concerned that Medicare is not seeking a more flexible advance payment policy, which will help ensure that cash flow interruptions do not threaten practice sustainability following the compliance date. To be clear, this is not a cash advance – it is payment for services already rendered by a physician that Medicare provides outside the normal reimbursement process.”

Another excerpt: “Medicare staff have suggested physicians hire consultants and use free Medicare Billing Software as a solution to address payment problems due to the transition to ICD-10.  Hiring a consultant is not an option for many cash-strapped physicians, and, if the problem is on Medicare’s end, there is no role for a consultant.”

Another excerpt: “Medicare has stated in numerous public forums that the move to ICD-10 is expected to result in fewer requests for attachments and additional information to substantiate claims before physicians can be reimbursed. We urge CMS to formally adopt a policy for Medicare that states when the most specific ICD-10 code is submitted by a physician no additional information will be required to adjudicate the claim, particularly in the absence of an attachment standard.”

Here’s how the letter concludes:”The AMA is committed to seeing physicians successfully transition to new payment and delivery reform models and adopt well-developed technology that promotes care coordination with real value to patients.  Adopting ICD-10, while it may provide benefits to others in the health care system, is unlikely to improve the care physicians provide their patients and takes valuable resources away from implementing delivery reforms and health information technology. The AMA strongly urges CMS to reconsider the ICD-10 mandate.”

The letter is online at:

Ken Pope


“First they came for the communists but I was not a communist so I kept quiet.  Then they came for the socialists and the trade unionists but I was neither, so I did not speak out.  Then they came for the Jews, but I was not a Jew, so I did not speak out.  And when they came for me, there was no one left to speak out for me.”
–Martin Niemoller, after being released from Dachau, 1945