"We've delayed this more than once and it's time to move on."
— CMS Administrator Marilyn Tavenner at Health Information Management Systems Society annual conference, February 2014
After years of planning, hours upon hours of training, and millions of dollars spent in preparation, the ICD-10 coding transition will not move forward on Oct. 1, 2014.
And while CMS' Tavenner and others in the federal agency stuck to their guns and reminded physicians every opportunity they could that ICD-10 was inevitable this year, they forgot to account for one wildcard: Congress.
Congress, in its annual attempt to find a solution to Medicare's broken Sustainable Growth Rate (SGR) formula has decided to enact another one-year, short-term patch … passing the 17th extension of the SGR's proposed reimbursement cuts for physicians via HR 4302. And on top of that, members of the House and Senate approved a one-line provision in the bill enacting a one-year delay for implementation of ICD-10, meaning that the earliest the coding transition can now take place is Oct. 1, 2015.
There's no doubt that the move away from ICD-9 is going to be difficult for medical practices, requiring possible investments in new IT software, training staff, and facing denials by payers for using the wrong codes, but ICD-10 was proposed almost a decade ago. It was then twice delayed before Congress decided to include it in its annual game of "kick the can down the road" with SGR. This year, the can steamrolled ICD-10 in its wake.
The reaction to the coding delay has been mixed. Some physicians are relieved that they have 17 months to prepare for ICD-10 vs. five months (but those were likely the ones who had yet to do anything to prepare) and others are livid that they have already invested the time and money to get their practices prepared for the now defunct 2014 deadline. It's likely they'll spend even more money to re-train and refresh for next year.
And then there is the AMA, no great fan of HR 4302 because it was another stop-gap measure on the SGR as opposed to a long-term solution that finally seemed to have traction in Washington, D.C., this year. But the powerful doctor's lobby is also shedding no tears over the delay in ICD-10, as it has been a loud opponent of the coding transition. In February, the AMA commissioned a new study showing that their initial cost estimates for implementing ICD-10 in 2008 — around $83,000 for a small practice and up to $2.7 million for large practices — was now more in the $226,000 to $8 million range. The AMA called ICD-10 a "crushing burden" for physicians when releasing the new data.
The fact is, the ICD-10 delay is now not about what is best for physicians, patients, or even healthcare overall — it's about politics. It is collateral damage in an ongoing, annual tug-of-war to get a short-term SGR patch passed yet again, wrapped up in the ongoing bipartisan war over healthcare reform.
Furthermore, it's a symptom of a larger disease that Washington, D.C., comes down with every year around March 31, when SGR cuts are due to take effect — bravado about finally doing away with an arcane payment formula, mixed with profuse sweating over how to pay for repealing the SGR, with touches of intense nausea by physicians over the inevitable non-action by politicians.
Perhaps someday, there will be a code for that.
Keith L. Martin is group editorial director for Physicians Practice. How do you feel about a delay in ICD-10 implementation? Tell us at [email protected]. Unless you say otherwise, we'll assume we're free to publish your comments in print or online.
This article originally appeared in the May 2014 issue of Physicians Practice.