Groups at odds over de­lay of ICD-10

Modern Healthcare - - NEWS - By Joseph Conn

It’s just one sen­tence in a 123-page bill passed last week by the House to tem­po­rar­ily patch Medi­care physi­cian pay­ment.

But depend­ing on who you lis­ten to, it could ei­ther save the health­care world from a huge fi­nan­cial de­ba­cle, or se­ri­ously set back ef­forts to ad­vance qual­ity of care and ac­cu­racy of pay­ment, and waste hun­dreds of mil­lions of dol­lars providers al­ready have in­vested in train­ing and sys­tems re­tool­ing.

That pro­vi­sion would push back by at least one year the fed­er­ally man­dated, al­ready twice-de­layed con­ver­sion to the com­plex ICD-10 di­ag­nos­tic and pro­ce­dural cod­ing sys­tem slated to be­gin Oct. 1. 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.”

The mea­sure was un­ex­pected, slipped into leg­is­la­tion to pro­vide a one-year patch for Medi­care’s sus­tain­able growth-rate for­mula. The Se­nate is ex­pected to vote Mon­day on the bill, which would avert a pos­si­ble 24% cut to physi­cian pay­ments tak­ing ef­fect April 1. It’s likely to in­clude the ICD-10 de­lay.

“I don’t know any­body who saw it com­ing,” said Dr. Frank Byrne, pres­i­dent of St. Mary’s Hospi­tal in Madi­son, Wis., who was con­fi­dent his hospi­tal would be ready for the Oct. 1 con­ver­sion.

It’s not known for sure what lob­by­ing groups or law­mak­ers were re­spon­si­ble for in­sert­ing the de­lay into the bill. The Amer­i­can Hospi­tal As­so­ci­a­tion and ma­jor in­sur­ers strongly op­pose additional de­lays in ICD-10 im­ple­men­ta­tion.

But the Amer­i­can Med­i­cal As­so­ci­a­tion and the Med­i­cal Group Man­age­ment As­so­ci­a­tion have lob­bied strongly for push­ing back the ICD-10 launch, say­ing many physi­cians and some ven­dors of elec­tronic health records and prac­tice man­age­ment sys­tems aren’t ready. They have ar­gued that go­ing ahead with an in­ad­e­quately tested new cod­ing sys­tem could lead to a billing and claims pay­ment crash that would cat­a­stroph­i­cally dis­rupt physi­cian prac­tices’ cash flow.

“The fact that Congress stepped in re­flects that there is a lot of con­cern,” said Robert Ten­nant, se­nior pol­icy ad­viser to the MGMA.

The de­lay, based on the bill’s lan­guage, could run longer than a year, and “gives us a whole lot of op­por­tu­ni­ties to ex­plore dif­fer­ent ap­proaches” to rolling out changes in tech­nol­ogy stan­dards in the fu­ture, Ten­nant said. He’s al­ready had one dis­cus­sion with the CMS, rec­om­mend­ing that they hold a se­ries of stake­holder meet­ings on how to pro­ceed.

Terry Gunn, CEO of Ker­shaw Health, said hav­ing more time to make the switch to ICD-10 would be a boon for his Cam­den, S.C.-based hospi­tal. “It’s a huge, overwhelming task,” Gunn said.

But a group of in­dus­try heavy­weights called the Coali­tion for ICD-10— in­clud­ing the AHA, the Blue Cross and Blue Shield As­so­ci­a­tion, the Amer­i­can Health In­for­ma­tion Man­age­ment As­so­ci­a­tion and the Col­lege of Health In­for­ma­tion Man­age­ment Ex­ec­u­tives—has op­posed additional ICD-10 de­lays. AHIMA has alerted its mem­bers and is en­cour­ag­ing them to call their sen­a­tors, ask­ing them not to sup­port the de­lay.

Jus­tine Han­del­man, vice pres­i­dent of leg­isla­tive and reg­u­la­tory pol­icy at the Blue Cross and Blue Shield As­so­ci­a­tion, said her or­ga­ni­za­tion would be lob­by­ing sen­a­tors over the weekend. “The Blues plans are on track to be ready,” she said. “We’ve been work­ing hard. We and our plans will make sure we make our po­si­tion known that we want to move ahead with­out fur­ther de­lays.”

Many health­care or­ga­ni­za­tions al­ready have spent large amounts of money and staff time on ICD-10 prepa­ra­tions over sev­eral years, re­ly­ing on Obama ad­min­is­tra­tion as­sur­ances that the Oc­to­ber 2014 dead­line would hold. CMS Ad­min­is­tra­tor Mar­i­lyn Taven­ner told her key­note au­di­ence at the Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety meet­ing a month ago that there would be no fur­ther de­lays.

“We put a ton of ef­fort into pre­par­ing for ICD-10,” said Dr. Brian Patty, chief med­i­cal in­for­ma­tion of­fi­cer at four-hospi­tal HealthEast Care Sys­tem, St. Paul, Minn. His sys­tem also has con­tracts for ex­tra coders for case re­view and to con­vert ICD-9 codes from an am­bu­la­tory elec­tronic health record run­ning on ICD-9 that’s be­ing phased out and won’t be re­placed un­til next year. “That’s lit­er­ally about a half a mil­lion dol­lars for var­i­ous con­trac­tors to cover us when we go up on ICD-10,” he said.

He and oth­ers warn that a de­lay would wipe out the ben­e­fits of physi­cian and staff train­ing in the new ICD10 sys­tem and force health­care or­ga­ni­za­tions to en­gage in an­other costly round of train­ing later.

“We just be­gan on­line train­ing for all our physi­cians about a month ago,” Patty said. About 200 have com­pleted two to four hours. That would have to be re­peated next year if the one-year de­lay is en­acted. But physi­cians are likely to be skep­ti­cal next time. “Come a year from now, are they go­ing to balk and say, ‘That’s what you said last time’?” he won­dered.

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