Good news and bad news for proponents of ICD-10 delay
Wednesday, April 02, 2014
It's déjà vu all over again for the healthcare field. Except this time it's a twofer.
With the passing of H.R. 4302, known as the Protecting Access to Medicare Act, on March 31, Congress delayed a permanent fix to the sustainable growth rate (SGR) payment formula for a 17th time. And ICD-10 was delayed for a fourth time. The only step needed to make both delays a reality is a signature from President Barack Obama.
Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner said in a speech at the annual conference of the Healthcare Information and Management System Society in February there would be no more delays to ICD-10.
Many groups, including the American Medical Association, continued campaigning for a delay despite Tavenner's comments, but few expected one to be granted this way. The ICD-10 provision in H.R. 4302 says the Department of Health and Human Services cannot adopt the ICD-10 code set before Oct. 1, 2015.
The move was especially surprising, and disappointing, to many industry leaders because a bipartisan group of House and Senate members announced in February it had reached a deal to repeal the SGR formula, which is used to determine payments made to physicians for services provided to Medicare patients.
That deal fell apart, and as lawmakers drafted what has become an annual patch to the SGR problem, they decided to placate those who were calling for a delay to the Oct. 1 ICD-10 deadline.
"While a delay in ICD-10 implementation provides welcomed temporary relief, it does not offset the continued harm caused by keeping the SGR formula on life support and further delaying badly-needed Medicare physician payment reforms," Dr. Ardis Dee Hoven, president of the AMA, said in an email to MultiBriefs Exclusive.
The 64-35 Senate vote that made the ICD-10 delay a reality came as especially troubling news to those opposed to another delay to ICD-10.
"We are extremely dismayed that this provision was included solely for political reasons — not because it is sound policy," said Sue Bowman, senior director of coding policy and compliance for the American Health Information Management Association (AHIMA), in a statement released by The Coalition for ICD-10.
In addition to AHIMA, coalition members also include the American Hospital Association, College of Healthcare Information Management Executives, the BlueCross Blue Shield Association and WellPoint.
Bowman said an overwhelming majority of healthcare organizations have already made significant investments to be prepared for the October deadline, "and we shouldn't all lose that effort for political reasons."
AHIMA took to Twitter as the Senate vote drew closer. Using the hashtag #nodelay, the organization reached out to numerous Senate leaders to express its concerns and urge a "no" vote on the bill. AHIMA issued a statement after the vote indicating that the delay to ICD-10 could cost the industry between $1 billion and $6.6 billion on top of expenses already incurred.
On the other side of the issue, the Medical Group Management Association was among those advocating for a delay to ICD-10. It conducted a survey in January that found less than 10 percent of physician practices were prepared for implementation.
While the group is pleased the ICD-10 delay was granted, it was supportive of the bipartisan plan for a permanent SGR fix and "we are disappointed that did not happen," said Robert Tennant, senior policy advisor for the MGMA.
College of Healthcare Information Management Executives President and CEO Russell Branzell said CMS needs to provide guidance on what the delay will mean.
"The delay leaves numerous unanswered questions from testing, training and revamping the agency's education resources, such as the CMS eHealth University, designed to help providers understand, implement and successfully participate in the conversion process," he said.
The American College of Radiology issued a statement in support of several of the provisions in the bill. It was especially pleased with a provision that would require ordering providers to consult physician-developed appropriateness criteria when prescribing advanced imaging procedures for Medicare patients. The bill also directs HHS to identify mechanisms, such as clinical decision support systems, that can be consulted by providers who are ordering imaging procedures.
The ACR also said the delay to ICD-10 will give radiology providers the needed time to prepare for the conversion.
Tennant agrees the delay will be beneficial to practices. He said they should use this time to focus on improving clinical documentation. Regardless of whether ICD-10 is implemented, improving clinical documentation will help practices improve their revenue and coordination of care activities, he said.
"In terms of the industry, I would argue this is an opportunity for CMS to do a reset," Tennant said. "Their traditional approach to transiting these types of standards clearly didn't work. We had delays, and still folks weren't ready."
The delay will also allow practices the opportunity to ensure their practice management systems are capable of meeting new standards, according to Tennant.
In March, two health IT industry groups, the Electronic Healthcare Network Accreditation Commission and the Workgroup for Electronic Data Interchange, joined forces to create the Practice Management Systems Accreditation Program. The program is expected to launch in the fall.
The ICD-10 delay will give practices in need of new practice management systems time to fully adopt an accredited system well ahead of the ICD-10 compliance date.
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