It took the Senate nearly five hours Monday to debate and approve a bill that would temporarily fix the sustainable growth rate for docs and also delay ICD-10 one year. The curious -- and disconcerting -- thing is, during that time not a single Senator made mention of the ICD-10 provision included in the bill, leaving many industry officials questioning: Do they even know what they just voted on? Either way, overall the folks in healthcare were not very happy.
Chief information officers chief among them.
Pamela Arora, senior vice president and CIO of Children's Medical Center Dallas, called the repeated delays of ICD-10 "concerning." In the end, the two delays will cost the hospital more than $1 million, Arora pointed out. "With this money, for example, we could purchase roughly 170 physiological monitoring devices and place more tools in the hands of our clinicians," she said. "Many of these types of purchases are delayed when the funds are constrained."
Added Arora, "Two years of cost overrun and missed deadlines would never be labeled a successful project in the private sector concerned about profit margins."
Others, too, expressed similar sentiments.
"Overall I am disappointed in the delay," said Ralph Johnson, CIO at Maine-based Franklin Community Health Network and president of New England HIMSS, "especially with the manner in which it was passed by the House and Senate. It was buried in larger legislation, never allowing anyone to shine a light on the delay during the debates."
[See also: ICD-10 delayed, doc pay patched again.]
Despite his disappointment, Johnson is thankful he works for a small organization that did not have any costs "sunk into ICD-10," he pointed out, which is not the case for many larger healthcare organizations that have invested time and big money to be ready for the previous ICD-10 go-live date of October 1, 2014. "We have been working on a 'just in time' delivery method for ICD-10, which is controlling the cost of implementation," Johnson said. "We learned that lesson when it was delayed last year."
The ICD-10 delay is no distraction for the folks at the 82-hospital Catholic Health East Trinity Health, at least according to Tauana McDonald, vice president of program excellence at CHE Trinity Health, and in charge of ICD-10 progress.
"CHE Trinity Health will continue moving forward with ICD-10 implementation and maintain momentum, with little regard for the delay," said McDonald, in a statement to Healthcare IT News. McDonald, who has previously stated that the health system needed every day leading up to the October 2014 deadline to be ready, said because the coding transition will help spur documentation excellence, improved patient care and effective population health management, ICD-10 "deserves our continued focus and attention."
The Twittersphere was also ablaze with ICD-10 speak for both the five hours leading up to the vote and the aftermath following.
"Saved by the bill? That awkward moment when an act of Congress delays your project deadline," wrote Mohamed Alyajouri, @Alyajouri, project manager at Multnomah County Health Department in Oregon.
"Ready for retraining everyone? Who knows... docs may actually take it more serious this time around," said Al Naqvi, @alnaqvi, executive vice president and chief financial officer at Illinois Health and Science.
Jim Porter, @MrJimPorter, regional finance officer of the 12-hospital Presence Health in Chicago, said "MAJOR disappointment - countless hrs & exp already in prep for 10/1/14 deadline."
Industry groups were also vocal about the Senate vote, which received the required signature by President Barack Obama on April 1.
The American Health Information Management Association, or AHIMA, expressed its "deep disappointment" with the Senate's vote to give the ICD-10 delay a green light. "On behalf of our more than 72,000 members who have prepared for ICD-10 in good faith, AHIMA will seek immediate clarification on a number of technical issues such as the exact length of the delay," said AHIMA CEO Lynne Thomas Gordon, in a press statement.
AHIMA officials cited CMS data suggesting a one-year delay could likely cost the healthcare industry up to $6.6 billion in addition to the costs already incurred from last year's delay.
"This delay will add an additional significant hurdle for the healthcare system to fill these important HIM positions," Thomas Gordon said. "It is truly unfortunate that Congress chose to embed language about delaying ICD-10 into legislation intended to address the need for an SGR fix in their effort to temporarily address the long outstanding and critically important physician payment issues."
The College of Healthcare Information Management Executives also expressed dissatisfaction with the Senate's vote to delay ICD-10 one year yesterday evening, with its President and CEO Russell P. Branzell saying the decision led to a "pause in momentum" that "discredits the significant work our industry has spent training staff, conducting testing and converting systems.
"The delay leaves numerous unanswered questions from testing, training and revamping the agency's education resources," added Branzell in a March 31 statement. "The ICD-10 delay comes at a critical time just as providers are implementing new care models that would benefit from greater coding accuracy and specificity, such as patient-centered medical homes and value-based purchasing."
Vendors were also not to be left out of the discussion, with some critical of the Senate's move.
Cloud-based EHR vendor athenahealth, for instance, was among them, calling the vote to delay ICD-10 "unfortunate" and a "distraction to providers."
"athenahealth and its clients are/were prepared for the ICD-10 transition, and in fact we have national payer data showing that 78 percent of payers are currently proving readiness in line with the 2014 deadline," said Ed Park, executive vice president and chief operating officer at athenahealth, in a March 31 press statement. "The moving goal line is a significant distraction to providers and inappropriately invokes massive additional investments of time and money for all," he added.
Park said it remains "alarmingly clear" the healthcare industry is operating in an environment where no penalty exists for failing to keep pace with deadlines and steps to move the industry in the forward direction. "Our system is already woefully behind in embracing technology to drive information quality, data exchange, and efficiency, and delays like this only hinder us further," Park added.
Not all industry groups were upset over the vote, however.
One of the most outspoken supporters of the delay was The American Academy of Family Physicians, representing more than 110,000 family docs nationwide, and who lauded the vote as a success for the industry.
"Family physicians welcome the new October 2015 start date for billing according to the highly complex ICD-10 system," said Reid Blackwelder, MD, AAFP president, in a March 31 statement following the Senate's vote. "We have long expressed serious concerns about ICD-10's functionality and the real potential for technical problems that could result in delayed payments for physicians," he said earlier to AAFP News.