Q&A: ICD-10 delay a 'pragmatic compromise without changing principles'

By Tom Sullivan
08:12 AM
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The newly-proposed ICD-10 compliance deadline of October 1, 2014 won’t please every healthcare organization. What it does accomplish, though, is to give them a bit of leeway in their project planning.

That’s the assertion of Kaveh Safavi, managing director of Accenture’s North America health industry unit. Safavi spoke with Government Health IT Editor Tom Sullivan about what the new date means to healthcare entities, just how far behind the industry really is and whether 2014 will really be the final deadline for the mandate that has already been pushed back more than once.

Q: With so many in the healthcare industry so far behind on ICD-10 – and by many accounts the two months since HHS first announced it would push back compliance has only stalled progress – one year seems a bare minimum. Is it long enough to really help?
A:
I think that the truth is if they didn’t push the deadline most organizations would have found their way to compliance. Certainly large organizations were on their way, the bigger challenge is [faced by] smaller providers. Ultimately, it would have fallen together, it just would have been difficult. The purpose was to give organizations some slack in planning because they’re not just doing this, they’re doing many other things. So it gives people a little chance to rearrange priorities and not keep a deadline to which they’d have to make tradeoffs they shouldn’t. I don’t think the intent was to have an extraordinarily long delay. I think they want everyone to understand the fact that ICD-10 is ultimately the destination.

Q: Once HHS announced intentions to delay the compliance deadline, there was a lot of angst and plenty of healthcare entities said that the change would actually drive the costs up – but most of those cries were coming from industry bodies and tech vendors that stand to profit from ICD-10. What sense do you get from your clients on this?
A:
Our clients are basically folding this into their planning schedule. They’ve pushed some things around and moved ICD-10 to the back end to get some other stuff done earlier. The health plans have all kinds of work under the Patient Protection and Affordable Care Act that they’ve been working on, assuming that the law’s the law unless the day comes when it’s not the law. On the provider side they have many other issues, including meaningful use. [In] the IT part of the organization, their hands are full. Just getting the latitude of twelve months is worth something to them in their planning cycle but anyone who thought that it was going to go away was making a mistake. It’s not going to go away. The reality is that this is a pragmatic compromise without changing the principles.

Q: What’s your understanding of how this delay happened in the first place? The AMA wrote letters to HHS Secretary Sebelius, and House Speaker John Boehner – there must be more to this than just a pair of open letters.
A:
I can tell you that these decisions are very complex. We work with HHS and CMS all the time and they contemplate both the internal reality of CMS, as well as the external reality of the constituents and it’s never just one thing. It’s always many things that go into a decision like that and my sense is, just as an observer, that they were balancing any number of factors, one piece of which was a particular constituency, not all of healthcare providers but certain ones, were asking for relief. Now the challenge, of course, is that they were asking not just for a delay but for ICD-10 to go away. And that wasn’t going to happen.

Q: Speculating here a bit, I suspect that when the AMA was asking for it to go away, that might have been a negotiating tactic more than anything. Surely they knew that ICD-9 wouldn’t last forever…
A:
And membership organizations ultimately make decisions that represent a compromise of many people in their group. So the position doesn’t necessarily represent any one position, it just happens to be the compromise of everyone. So who knows?

Q: Given that even HHS cited a WEDI readiness survey statistic that nearly 50 percent of the 2,140 providers responding did not know when they would complete their impact assessment, will October 1, 2014 really be the final deadline?
A:
That’s not a technical decision. That’s much more a regulatory and political matter. We have no way of knowing the answer. My position is to assume it is unless you hear otherwise because it would be a mistake to bank on it not being that day.
 

Related coverage:

The imminent industry association war over ICD-10

If HHS delays ICD-10 just long enough, could the U.S. leapfrog to ICD-11? 

Could ICD-10 have as big an impact as the mortgage crisis? Yes, here's why

ICD-10's ten-year reign of fear

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Sue Murphy, RN, chief experience and innovation officer, patient experience and engagement program, at The University of Chicago Medicine: "One thing we do in keeping senior leaders involved is send information to them in a very data-driven, date-based fashion, so they know they will see certain patient experience outcomes metrics, for example, between the 15th and the 18th of every month."