Lines are being drawn between physician organizations and other healthcare groups over how quickly the industry should adopt a new coding system for inpatient procedures.
The debate stems from an Aug. 15 announcement by HHS that it wants to switch the nation from the current diagnoses and inpatient procedure codes set under the International Classification of Diseases, Ninth Revision, or ICD-9, to those under ICD-10. HHS also proposed to mandate an upgrade of the Accredited Standards Committee X12 data transmission standards from the current Version 4010 to Version 5010 by Oct. 1, 2010. The data standards change is needed to handle the longer and far more numerous and complex ICD-10 codes.
The public comment period on the proposed rules closed Oct. 21 and unleashed a string of pronouncements on the subject with several of them clashing over what the deadline for implementation of ICD-10 should be.
HHS proposed an ICD-10 deadline of Oct. 1, 2011, a number that many argue is too soon. The Medical Group Management Association has been one of a number of vocal healthcare industry groups critical of the proposed rules, which were officially published Aug. 22. The MGMAs position, shared by the American Medical Association as well as a host of other medical societies, health plans and others, is that HHS is pushing too far too fast on changes that will cost the industry tens of billions of dollars.
AMA board Chairman Joseph Heyman, M.D., says the costs, training and impact of the transition have been underestimated by HHS. Heyman says physicians are concerned about what he described as a hasty transition to ICD-10, particularly if the rollout is done as planned by HHS, that is, concurrently with the implementation of the 5010 data standard.
Heyman says the AMA, in its formal comments submitted to HHS, called for a bifurcated implementation process more in keeping with recommendations by the National Committee on Vital and Health Statistics. The AMA asked for the initial rollout of 5010 electronic claims standards to take at least three years. The deadline for the ICD-10 codes should not be set earlier than at least five years after formal publication of the 5010 final rules, and not until at least 95% of the industry is successfully using the 5010 standard, Heyman says.
The MGMA and others also have pushed for disclosure of information regarding a $3.2 million study the federal government is paying the American Health Information Management Association to conduct. AHIMAs official position on when ICD-10 should be implemented has not always been clear.
Overall, HHS request for comments drew more than 3,000 responses, says CMS spokesman Joseph Kuchler. Those comments should be reviewed and the final rules on ICD-10 and 5010 should be completed just before the executive branch turns over in January, according to Kuchler.
At least one healthcare lobbyist predicts that post-election, the pending HHS proposed rules could be put on hold to be reviewed and possibly modified by the incoming Obama administration. House Speaker Nancy Pelosi (D-Calif.) has been requesting input from us and others about concerns they have with pending regulations, says Robert Tennant, senior policy adviser on health information technology for the MGMA. It is fairly typical of new administrations to put on hold any new regulations.
If HHS makes good on its promise and publishes the final rules on 5010 and ICD-10 before the Bush administration departs, the MGMA and others will lobby the new Obama administration to amend them, Tennant says. The MGMA is calling for at least a six-year rollout period and even with that is warning against establishing a hard compliance deadline.
AHIMA came out foursquare in support of HHS when it announced the proposed rules for 5010 and ICD-10 in mid-August, but AHIMA officials have hedged in several public utterances since then when it came to the controversial HHS timelines and the Oct. 1, 2010 deadline for 5010 and Oct. 1, 2011, for ICD-10.
For example, when the proposed rules were first announced, Sue Bowman, AHIMAs director of coding policy and compliance, said we havent talked about whether the deadlines were doable. And on Oct. 13, in a guest editorial in sister publication Modern Healthcare, AHIMA Chief Executive Officer Linda Kloss said our industry needs to make this happen soon and the U.S. has reached the witching hour on this decision while naming, but not specifically endorsing, the ICD-10 deadline.
On Oct. 28, AHIMA, the AHA and the Advanced Medical Technology Association sent letters to members of Congress saying they strongly support the HHS 5010/ICD-10 proposal and that the time for moving forward is long overdue while again, not specifically mentioning the controversy over the HHS deadlines.
So, it came as something of a surprise that AHIMA, in its Oct. 20 official comments on the proposed rule, called for an implementation date no later than Oct. 1, 2012. In other words, AHIMA was supporting a delay of a year past the date in the HHS proposal, while still supporting a three-year rollout and still urging HHS to issue a final rule before the end of this year. (Any compliance date, whatever the year, would have to be on Oct. 1 to align with the effective date of Medicare payment updates, according to HHS.)
Why the new position? Dan Rode, vice president for policy and government affairs at AHIMA, says the group had been supporting a three-year timeline for several years. In August, when HHS announced the proposed rule, We were still looking at it as doable, but the closer we got to Oct. 1wed put a draft copy out to our members by mid-September and we had town hall meetingsby the time we were up to getting the comments in (to HHS), it was obvious that three years wouldnt work, Rode says.
In April, the MGMA, the AMA, a host of medical specialty societies and the Blue Cross and Blue Shield Association, sent a joint letter to HHS Secretary Mike Leavitt asking for the CMS to release the scope of work for a $3.2 million study it had hired AHIMA to perform, looking into the impact the ICD-10 conversion would have on the CMS and Medicare.
The coalition raised the issue of the lack of transparency in the contracting process and expressed concern whether AHIMA could be independent in its work because the implementation of ICD-10 should be a significant growth driver in their business.
Rode says AHIMA does charge for and make money on training programs, but it is not now, and will not be in the future, the only organization that will be selling services as the ICD-10 conversion moves forward.What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.