The unexpected legislative ICD-10 delay, tucked away into just one sentence in the SGR bill signed this week by President Obama, is making a big impact across the healthcare industry. It reads: “The Secretary of Health and Human Services may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for codes sets.”
Thousands of healthcare organizations – providers, payers, vendors, clearinghouses – already have spent enormous amounts of money and effort on ICD-10 preparations, many over several years. Many are in the midst of final preparations, after repeated assurances by CMS that there would be “no more delays.”
It is widely agreed that the first ICD-10 delay, when CMS changed the deadline from October 1, 2013 to October 1, 2014 had the opposite effect than intended on many healthcare organizations. Instead of using the extra time to systematically manage the complex process of converting from ICD-9 coding to ICD-10, many hospitals and physician organizations held off on any actions — some until as recently as the beginning of 2014. This inaction put these providers at great risk of not meeting the October 1, 2014 deadlines, and experiencing major financial disruptions.
Many hospital leaders and physicians spoke openly about the potential for another delay, arguing that if one delay could be engineered through the confluence of bureaucracy and lobbyist pressures, why not another? To the surprise of those who have embraced the ICD-10 move, the nay-sayers were right.
The political context of this one-sentence sweetener to the SGR bill is grating for many. “Almost every association, the vast majority, are not only surprised, but definitely not in favor of this,” CHIME CEO and President Russell Branzell said, earlier this week. Sue Bowman, Senior Director of AHIMA said, “We are extremely dismayed that this provision was included solely for political reasons – not because it is sound policy. An overwhelming majority of the health care community has made enormous investments into being ready for adoption in October – and we shouldn’t all lose that effort for political reasons.”
The financial and operational consequences of the delay are significant. The pressure is now on CMS, who has been conspicuously silent in the last two weeks. Providers, vendors and payers are now in a quandary, and will be until CMS steps up to the plate and provides some new and believable answers to a very problematic situation. Budgets, ICD-10 implementations, training of coders, new data analytics projects, vendor contracts, and many jobs are on the line. Billions of dollars have either already been wasted, and/or are about to be. What happens now?
CMS should work on getting the answer to this question sooner rather than later.
The Office of the National Coordinator for Health IT (ONC), the Federal Communications Commission (FCC), and the Food and Drug Administration (FDA) jointly released a report detailing the strategy and recommendations for a health information technology (health IT) framework this week.
The report outlines a strategy that identifies three categories of health IT: