Proponents of implementing the ICD-10 diagnostic and procedural coding system are vowing not to be ambushed during this year's “doc fix” legislation debate in Washington. A last-minute delay in ICD-10 implementation for 2014 surprisingly was tucked into last year's federal “doc fix” bill.
Talks about how to stave off a 21.2% cut in Medicare payments to doctors have heated up on Capitol Hill in recent days. Legislators have until March 31 to pass legislation to prevent the sustainable growth-rate formula from being implemented. Most healthcare policy watchers expect them to once again pass a temporary fix in the realm of three to nine months, which would be the 18th consecutive patch.
If that proves to be the case, it would be deeply disappointing to doctors, who have been clamoring for an end to the SGR merry-go-round for years. That raises the prospect that Congress will seek to placate physicians by once again delaying ICD-10 implementation, since they've been the biggest skeptics of the coding system. Some key Republican House members, in particular, remain deeply skeptical of ICD-10 implementation, now scheduled for Oct. 1 this year as a result of last year's legislated delay.
“It's clear to me that some staffers are trying to figure out a way to assuage the concerns of some in the physician community,” said Ilisa Halpern Paul, president of the District Policy Group at Drinker Biddle & Reath.
That's why ICD-10 backers are on Capitol Hill this week to make the case that the SGR debate should not be used as an excuse to once again delay implementation.
“Because of what happened last year we have to be concerned about that as an opportunity,” said Richard Averill, director of public policy for 3M Health Information Systems, who was among those lobbying on Capitol Hill. “To the best of our knowledge, there's nothing explicit happening at this moment in time.”
The American Medical Association and its allies are stopping short of calling for a delay, at least publicly. In a letter sent to CMS Deputy Administrator Andy Slavitt (PDF) last week, 100 provider groups called for beefed up testing and additional assurances that audits won't be used to scrutinize if providers used the most appropriate ICD-10 codes.
“The implementation of ICD-10 is a massive undertaking,” the AMA and its allies wrote. “The undersigned organizations remain gravely concerned that many aspects of this undertaking have not been fully assessed and that contingency plans may be inadequate if serious disruptions occur on or after October 1.”
But some state medical associations, including Texas, the largest such group in the country, are still fighting implementation. They argue that doctors have been subject to an onslaught of costly government edicts in recent years that threaten to drive more physicians reluctantly into the arms of hospitals, or even out of business completely.
“Finally, you get to the breaking point,” said Dr. Austin King, president of the Texas Medical Association.
“We just can't do it anymore.”
Niko Corley, director of legislative and public affairs for the Alabama Medical Association, noted the coding system is particularly onerous for small physician practices, which are crucial in a predominantly rural state such as Alabama. But Corley's not optimistic about the prospects for shoehorning an ICD-10 delay into the SGR bill. “I don't think anybody expects that we're going have an ICD-10 fix put in there, as wonderful as that would be,” he said.
Last month, the CMS released the results of the first round of ICD-10 end-to-end testing. It showed that 19% of claims were rejected, almost entirely because of errors made by claims filers.
That's led ICD-10 foes to predict widespread confusion and billing errors if implementation moves forward on Oct. 1. But proponents of the coding system point out that only 3% of those claims were rejected because of invalid submission of ICD-10 codes.
Any push for delay is likely to come from the House. There remains hostility toward the coding system among some key members of the GOP caucus. Rep. Tom Price (R-Ga.), who chairs the Budget Committee, spoke out against it last month at the American Medical Association's conference in Washington. "ICD-10 I believe to be a debacle to the practicing physician," said Price, an orthopedic surgeon. He urged the assembled physicians to lobby their legislators for further delay.
Similarly, Rep. Andy Harris (R-Md.) floated the possibility last month during a hearing before the Appropriations Committee of a “hardship exemption” for doctors who couldn't afford to convert to the ICD-10 codes. They would be allowed to use the old coding system beyond Oct. 1.
“I fully understand how the government thinks. Everybody should switch to the regulatory scheme imposed by the government,” said Harris, an anesthesiologist. “This is one of the largest concerns of small physician groups.”
Leslie Krigstein, director of government affairs for the College of Healthcare Information Management Executives, said that having two coding systems used at the same time would sow only confusion, especially for accountable care organizations and other providers that are trying to integrate care delivery. “Having multiple codes that don't translate isn't going to help the situation,” Krigstein said.
That assessment is shared by the Obama administration. “CMS and many commercial health plans are unable to process claims for both ICD-9 and ICD-10 codes submitted for the same dates of service, so a 'transition period'—in which providers could submit claims using either ICD-9 or ICD-10—is not possible,” the agency noted in a fact sheet devoted to the issue.
Krigstein and other supporters of ICD-10 implementation are guardedly optimistic that any efforts to further delay or derail the coding system won't gain traction. She pointed out that further postponement would be detrimental to insurers, providers and other organizations that have spent heavily to prepare for the Oct. 1 implementation date. “Our members have made an enormous investment,” she said. “They've been ready. Their biggest hurdle now is certainty.”
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