The natives are getting restless about ICD-10. Again.

Since it looks like a new Congressional SGR patch (the Protecting Access to Medicare Act of 2014) will be needed by the end of March, another one-liner ICD-10 delay could get slipped into the legislation — just like last year. There is also alternative  talk about touching up some other unrelated legislation with a few choice words, to get ICD-10 off our plate for at least another year. Activist organizations on both sides of the ICD-10 controversy are voicing renewed concerns about this year’s October 1 deadline for implementing ICD-10.

Of course, there’s always talk about delaying ICD-10. And plenty of lobbying. So far, it’s been effective. The final rule to convert from ICD-9 coding to ICD-10 was issued in 2009 with a proposed implementation date of October 1, 2011. That date was pushed out to 2013, then delayed to 2014 by CMS.  Last year in March,  Congress entered the fray with its surprise move to hold off the deadline until October 1, this year.

Once again, over the last week, the warriors for both sides of the ICD-10 implementation issue have been gathering to take their best shots.

FOR ICD-10: On March 3, a group of 22 healthcare organizations representing 130 hospitals, nearly 1500 clinics, and almost 20,000 providers in 14 states wrote Congress’ leaders to urge no further delay in the implementation of ICD-10 beyond October 1,  2015.  They stated that their organizations had invested “substantial time and financial resources in preparing for roll-out of ICD-10” and that delaying implementation again would “cause a great deal of waste and create unnecessary expense.” The letter estimated that the organizations could be penalized by as much as 30 percent of their investments with further delays. Noting that other countries have adopted and been using ICD-10 since as early as 1995, the letter described ICD-10 as a “critical tool in aiding quality improvement and patient safety efforts.”

AGAINST ICD-10: The next day, March 4, the American Medical Association and 99 other physician-based associations  went on the attack. They sent a letter to the Centers for Medicare & Medicaid Services (CMS)  stating that they “remain gravely concerned that many aspects of this undertaking have not been fully assessed and that contingency plans may be inadequate if serious disruptions occur on or after October 1.” The letter noted several concerns, including CMS’ “limited” testing program,  how collection of quality data will be handled during the transition, and the potential for cash flow disruption if no contingency plans are in place. The letter also questioned the readiness of EHR vendors,  and the specificity of codes that Medicare claims will require (and that CMS will consider in audits).

Another delay in the implementation of ICD-10 would be disastrous for the advancement of healthcare quality in this country, at least for the next few years. The consequent loss of confidence in CMS and Congress on this issue would render almost any new ICD-10 deadline or plan a non-starter — even a bad joke — for many healthcare organizations. Their leaders simply would not believe a new ICD-10 plan to be real, and would not put ICD-10 on their agendas or in their budgets. A new factor will be that 2016 is an election year. A lot of things change in election years or get put on hold until the politics shake out, and there would be every reason to think ICD-10 could be one of them.

Many of my colleagues and I have seen few advances in implementing ICD-10 among hospitals since last year’s delay, and industry surveys have confirmed this generally apathetic status.  What we’ve seen instead is a waiting game to see who will win the battle this year — the FORs or the AGAINSTs?

It just so happens that AHIMA is holding a Twitter rally for ICD-10 TODAY, March 12. If you’re a tweeter, and FOR ICD-10 implementation by this October 1 — go FOR it!