Rug gets pulled out from ICD-10

In a surprise move this spring, Congress delayed the program again; that's cost valuable momentum, some say
By Mike Miliard
02:27 PM
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When 2014 began, industry groups – hospitals, physician practices, payers, vendors – were working diligently and dutifully toward an Oct. 1 ICD-10 deadline that had been on the horizon for years.

In just nine short months, at long last, the switch would finally be flipped and a galaxy of more granular codes would be put to work.

And then, in March, a 51-word piece of legalese was surreptitiously slipped into the House of Representatives' Sustainable Growth Rate "doc fix" bill:

"The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations."

As we put it when first reporting on the news: "such a brief mention for a bold idea."

Indeed. The healthcare industry had been working hard, for a long time, to get ICD-10 up-and-running once and for all. And here's this little clause, threatening to derail the whole effort for at least year.

Sure enough, the House bill passed, was ratified 64 to 35 by the Senate on April 1, and was soon off to President Barack Obama's desk to be signed into law. This despite the fact that the ICD-10 component seems to have been hardly noticed by many of the lawmakers voting on the SGR bill.

This bill is very disappointing,” said Democratic Michigan Rep. Sandy Levin during the House debate. “We got this bill just 24 hours ago.”

“I challenge any member to come up here and say, 'I have read this bill,'” said Democratic Maryland Rep. Steny Hoyer. “None of us know what the substance of this bill is.”

In the aftermath of the law's passage, healthcare stakeholders of all types tried to adjust to this surprising new reality. 

Pamela Arora, senior vice president and chief information officer of Children's Medical Center Dallas, told Healthcare IT News that these repeated delays of ICD-10 are "concerning."

Worse, they'd already cost her hospital more than $1 million, she said. "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, adding: "Two years of cost overrun and missed deadlines would never be labeled a successful project in the private sector concerned about profit margins."

Vendors were frustrated, too. Ed Park executive vice president and chief operating officer of Watertown, Mass.-based athenahealth said the unexpected delay was an “unfortunate” state of affairs.

“It is alarmingly clear that healthcare is operating in an environment where there is no penalty for not being able to keep pace with necessary steps and deadlines to move the industry forward,” he said.

Congress, he added, had created “a significant distraction to providers and inappropriately (invoked) massive additional investments of time and money for all."

A poll conducted by AHIMA in April found that a whopping 88 percent of respondents were disappointed by the ICD-10 delay. In addition, 42 percent of respondents said their organization had already spent more than $1 million on implementation, and half said they would, if allowed, be interested in voluntary reporting of ICD-10 codes beginning on Oct. 1 2014.

As it happened, in August, HHS finalized and approved the new ICD-10 compliance date: Oct. 1, 2015.

Whether that changes the next time a "doc fix" bill comes around – as one almost certainly will, since there have been 17 of them in the past 11 years – remains to be seen.

In the meantime, a survey released in September by the Workgroup for Electronic Data Interchange suggested critical momentum was lost this past year as payers, vendors and providers eased up on the ICD-10 gas pedal.

While all three groups "continue to make progress," WEDI Chair Jim Daley wrote in a letter to HHS Secretary Sylvia Mathews Burwell, "some tasks are slipping into 2015, particularly those related to testing."

Especially in hospitals and ambulatory practices, "it appears the delay has negatively impacted provider progress, causing two-thirds of provider respondents to slow down efforts or place them on hold," he added.

"Unless all industry segments make a dedicated effort to continue to move forward with their implementation efforts, there will be significant disruption on Oct. 1, 2015," Daley wrote.