Groups at odds over delay of ICD-10

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 KershawHealth, 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 ICD-10 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.

Follow Joseph Conn on Twitter: @MHJConn