Reaction to ICD-10 Delay Mixed Ahead of Senate Vote on 'Doc Fix'

On Monday, the Senate is scheduled to vote on a bill (HR 4302) that would implement a temporary fix for Medicare's sustainable growth rate formula and delay the ICD-10 compliance deadline until 2015, The Hill's "Floor Action" reports.

Senate Majority Leader Harry Reid (D-Nev.) announced the upcoming vote on Thursday, after the House approved the measure by voice vote (Cox, "Floor Action," The Hill, 3/27).

Background on ICD-10

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The switch means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes.

In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date from Oct. 1, 2013, to Oct. 1, 2014, partially to look at the incremental changes needed in reforming health care.

Last month, CMS Administrator Marilyn Tavenner told an audience at the Healthcare Information and Management Systems Society's annual conference that there would be no more delays to the ICD-10 compliance deadline.

How Bill Would Affect ICD-10

The House-approved "doc fix" proposal, introduced by Rep. Joseph Pitts (R-Pa.), would push back the ICD-10 compliance date to 2015.

The measure states, "The Secretary of Health and Human Service may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for codes sets." It also cites sections in the Social Security Act and the Code of Federal Regulations, which contain the secretary's authority to mandate the new code sets.

CMS estimates that a one-year delay of ICD-10 could cost between $1 billion and $6.6 billion, according to a blog post by the American Health Information Management Association, which opposes the bill (iHealthBeat, 3/27).

Health Care Industry Divided on ICD-10 Delay

Many hospital CIOs have expressed concern over the possible delay of the ICD-10 deadline, noting the amount of training and funding that has been spent on the conversion, FierceHealthIT reports.  

Linda Reed, CIO of Atlantic Health System in New Jersey, said, "From a hospital perspective, enough already. We've spent the money, done the work and started all the training." She added that from a physician perspective, another year-long delay is unlikely to solve implementation issues.

Similarly, Roger Neal -- vice president and CIO at Duncan Regional Hospital in Oklahoma -- said, "Too many investments in time and money have gone in on [ICD-10] to just say 'nope, not doing it'" (Bowman, FierceHealthIT, 3/27).

In addition, Brian Patty -- chief medical information officer at HealthEast Care System in Minnesota -- said the decision could jeopardize hospitals' relationships with affiliated providers. He said, "I think that the lost good will we've had with our providers will be the biggest hit."

However, other health care providers welcome the proposed delay, Modern Healthcare reports.

Terry Gunn, CEO of KershawHealth in South Carolina, said the delay would give the hospital more time to get ready for the "huge, overwhelming task" of ICD-10 implementation (Conn et al., Modern Healthcare, 3/27).

After the House vote, Medical Group Management Association senior policy adviser Robert Tennant said that the proposed delay is "recognition that the industry is simply not ready for the transition" (iHealthBeat, 3/27).

However, in an interview with EHR Intelligence, Tennant acknowledged the difficulty of the matter, saying, "There is no win across the board. If they delay it, then those folks that are ready and that do agree with the change and want it ... well, they're not going to be happy ... [a]nd if you keep a hard date and the system fails, then that's simply unacceptable."

He added, "The reality is that we have to keep the health care system working," noting, "The most important thing, at least in my mind, is that the claims continue to get paid and patients are seen" (Bresnick, EHR Intelligence, 3/27).

John Halakama, CIO of Beth Israel Deaconess Medical Center in Boston, also appeared conflicted about a delay. He said, "I can see both sides," noting that "the hospital mechanism is ready," while acknowledging that carrying out the transition is much more difficult for physician practices (Walsh, Clinical Innovation & Technology, 3/27).

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Steve Sisko
Terry....CPT coding? Canada? You do understand that ICD-10-CM is about "diagnoses." ICD-10 Diagnoses codes are what 98% of people are concerned about.The PCS codes are the codes you are comparing to CPT codes. And these PCS codes are only used by facilities (you may know these as hospitals) http://www.uthouston.edu/dotAsset/2409977.pdf
Michael Milne
Terry, if you are from Canada you are confused. The US CPT coding is NOT used in Canada. Each province has its own way of handling billing coding. Most provinces do not use ICD-9 codes as by the US definition but may have a schedule that is similar or based on the ICD-9s so diagnosis can be matched to billing. In a province like New Brunswick NO codified diagnosis schedule (ICD) is used. Doctors are generally better trusted in Canada by government, and paid by procedure with a basic assumption it is required. As for not making any money, it is unfortunate you have difficulty. practice management including accounting and human resources should be taught at medical school as it affects patient care. The median NET income of a doctor in Canada is actually slightly above the median of an US doctor, although US doctors have many much higher, but they also have doctors going bankrupt which never happens in Canada, except for those with drug or alcohol problems.
Terry Amiel
Steve Sisko, I believe you are the one misinformed. I'm from Canada and the ICD coding isn't necessary in the private practice but CPT coding is. Apples and oranges. Canadian private practice physicians are not burdened by the cost of implementing ICD-10 but we will be. Why should I have to pay for a bridging loan at all because it will not benefit patient care or outcome costs me money and only serves those who want Big Data like ins. cos. and CMS and Oh let's not forget the IT vendors who are raking it in at my expense. I can't afford EMR let alone the conversion to ICD-10. Oh again and those BMW's in the parking lot are likely those ON food stamps. My wife's car is an 8 year old Hyundai and I have a 7 year old Dodge truck. I had a woman pull up in an escalade, with bling on her hands, Gucci bag, nails and chic gear and all her kids are on Medicaid. All the kids had their own I-phones and she wanted them all seen, just in case. ICD-10 will be a nightmare to small practices for sure.
Davis Graham
Steve you state, "Cash reserves are meant as a bridge in case claims payment is delayed due to lack of preparation on either provider and/or payer side. If there is a delay, claims will eventually be paid and reserves will be restored. Claims will be paid. With all due respect you seem unacquainted with reality." Then when a practice goes out and gets a credit line; who will pay the interest? What person or practice who is well established, would go out and get a credit line to do business for the entity who owes you money?
Davis Graham
Steve Sisko, ICD-10 will have more than 155,000 different code variations in comparison to the current ICD-9, which has 17,000 (ICD Common n.d.). In Florida there are 1058 insurance plans and you are saying they are all ready? Even so if the single family practitioner is versed on the additional 140K+ code variation? Of the 1058 Insurance plans, are they going to pay a practice if they don't have the right CPT and ICD-10 code combination? Are you also saying a physician who bought a practice in 2012 and built a new building on the then current CMS reimbursement, then last year alone CMS reduced the reimbursement by 5%, the builder will come back and say I'll give you 5% off your building? Of the $716 billion that the Affordable Care Act cuts from the program over the next ten years, the largest chunk—$415 billion—comes from slashing Medicare’s reimbursement rates to hospitals, nursing homes, and doctors.

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