Well we are down to the sweet sixteen and in just over a week someone will be cutting down the nets in Arlington, Texas. No games scheduled during normal business hours next week, so office productivity should return to normal soon. Speaking of cutting down nets, many of you expected to be cutting down the ICD-9 nets by October 1. (That’s 186 days from now, but who’s counting.) However, our friends at the Federal Government may have other plans for you. Congress has teed up yet another “temporary doc fix” (the 17th such fix if you are keeping score at home) to avert the 24% cut SGR will impose on March 31. Buried in the proposed SGR legislation is another delay in the ICD-10 transition date.
Another delay?
The bill as written today would push the transition date out another year. If adopted, CMS (and presumably other payers) would not require an ICD-10 prior to October 1, 2015. The bill states: “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.”
ICD-9 was adopted by this country in 1978. The rest of the industrialized world made the transition to ICD-10 years ago. If this latest delay comes to pass it will mark the fourth time the ICD-10 transition has been postponed in this country. And, by the way, did I mention the World Health Organization will release ICD-11 in 2017?
Unintended consequences
Perhaps lost in this madness are the unintended consequences such a delay will impose. It probably comes as no surprise to this audience that health systems, medical practices, and health information technology vendors of all shapes and sizes have been spending a lot of time and money preparing for the transition. Some of this “sunk cost” will be reclaimed if the transition is delayed, but a significant piece will be lost. This creates an unrecognized opportunity cost to the health care system, which will have wide-spread ripple effects across the health care system.
Consider for the moment the fact that all entities involved in health care have a finite number of resources. This is true if the entity is a small medical organization, a large vertically integrated health care organization, or a health care software vendor. When a delay such as the one proposed occurs this late in the game, the customers of these health care entities—be they nephrology patients, nephrology practices, or nephrologists—are basically “robbed” of what might have been if the lost resources had been devoted elsewhere.
The maddening piece to this march is the collateral impact on other program deadlines nephrologists face today. Absent a delay, the 2014 meaningful use reporting periods were conveniently tied to a calendar quarter. This provides an opportunity to attest before Q4, allowing the focus to shift from meaningful use to the ICD-10 transition. Delaying the ICD-10 transition means we will lose the convenience this timing afforded.
Don’t let it happen
Organizations as diverse as the AMA and AHIMA are calling for members to reach out to Congressional representatives and ask them to remove the ICD-10 language from this bill. Marc Probst, CIO at Intermountain Health, perhaps said it best last month, “I would say October is going to be a really difficult month—and costly from a cash-flow perspective. Still, I do think we ought to go with [ICD-10] this October. Just rip that freaking Band-Aid off and get going.”
I certainly agree with Marc. Kicking this can further down the road only delays the pain. I would be interested in your thoughts about the proposed ICD-10 delay. Drop us a comment, and let the madness begin.
Terry Ketchersid, MD, MBA, VP, Clinical Health Information Management says
Actually the AMA is asking members to encourage their represntatives to vote “no” on the bill-not specifically remove the ICD-10 language. Apologies for the error.
Marilyn Pagel says
I agree that although many health care providers naturally dread implementation of ICD-10 as they may dread anything drastic and new. Our practice has already invested time and money in educating staff and physicians, purchasing books, paying for seminars, conducting meetings and communicating with vendors to make sure we are on the path to being ready for October 1, 2014. We have been told repeatedly by Kathleen Sebelius and others that there will be no delay. We have proceeded accordingly. I think we need to move forward with ICD-10 without delay and put the dysfunction of our legislatures behind us.
Terry Ketchersid, MD, MBA, VP, Clinical Health Information Management says
I could not agree more Marilyn. Unfortunately our votes were not counted as the House passed the bill on Thursday and the Senate followed suit yesterday. The President was expected to sign the temporary doc fix (number 17 since 2003) last night and along with it delay the ICD-10 implementation at least until October 1, 2015.