With ICD-10 now on Congress' radar, it's put up--not shut up--time

It seems as if finally--after three delays and endless back-and-forth arguments about merits, costs and complexities--the transition to ICD-10 will happen this October. To briefly recap:

  • First, the deadline was set for October 2011. Then this happened in January 2009
  • Then, the deadline was set for October 2013. Then this happened in February 2012
  • Then, the deadline was pushed back to October 2014. Then this came out of left field last spring

Will the fourth time be the charm? If last week's House Energy and Commerce's Health Subcommittee hearing on ICD-10 is any indication, the answer to that question should be an emphatic yes. The proceedings featured seven witnesses, only one of whom opposed the transition. The lone voice in opposition, urologist William Jefferson Terry from Mobile, Alabama, couldn't even find solace in a fellow rural physician from Missouri, the latter of whom said he's been ready for ICD-10 for years.

In fact, the proceedings were so lopsided, they prompted one lawmaker, Rep. Gene Green (D-Texas), to comment to Terry that he must have felt like he was at the Alamo.

What's more, the hearing was preceded by the publication of a Government Accountability Office report which determined that the Centers for Medicare & Medicaid Services has taken positive steps to help the healthcare industry prepare for ICD-10.

The whole production, from a bird's eye view, had the feel of a dog-and-pony show in favor of implementation. After all, those running the hearing--Reps. Joseph Pitts (R-Pa.) and Fred Upton (R-Mich.)--could very well have invited other dissenters to the party.

The committee, however, is in the midst of pushing its 21st Century Cures initiative, and aims to have a bill on President Barack Obama's desk by year's end. Since ICD-10 detractors often are seen as Luddites (as ICD-9 is more than three decades old), an anti-implementation stance seemingly would not be the best approach to getting proposed health innovation legislation signed into law.

This (Congress members taking a position on ICD-10) is not necessarily a bad thing. After all, last year when ICD-10 was delayed, they were rendered speechless. It's probably safe to say that, at the time, many in Congress had no idea ICD-10 was even being pushed back. At least this time if ICD-10 is included in another doc-fix bill, lawmakers will be on record as having discussed it beforehand.

However, it also would be unwise to ignore providers like Terry simply because they are in the minority. Are some providers opposed to ICD-10 because they are stubborn and stuck in their ways? It's very likely. But Terry also brought up some valid concerns, such as bumps in the road following the transition, and the abilities of various types and sizes of provider organizations to implement ICD-10 in the same manner.

"Everybody can't run a 4-minute mile," Terry said. "Some doctors aren't going to be able to do it. Do they deserve a death sentence; to be put out of business?"

The answer, of course, is no.

Perhaps, then, it's time to seriously consider giving providers in need more than just a few testing periods and some literature on making the switch. As ICD10Watch author Carl Natale mentioned last fall, if Congress were to find a way to fund implementation costs for small medical practices and independent physicians, the transition wouldn't be nearly as much of a hot-button issue.

I'd love to hear Congress' thoughts on that, particularly since ICD-10 now, all of a sudden, is on federal lawmakers' radars.

But that's probably asking too much. - Dan (@FierceHealthIT)