Proposed ICD-10 delay elicits mixed reaction from health industry

The healthcare industry had a mixed response to yesterday's proposal by the Centers for Medicare & Medicaid Services (CMS) to delay the deadline for ICD-10 implementation from Oct. 1, 2013 to Oct. 1, 2014.

That's not unexpected. In February, when CMS announced that the transition to the new diagnostic code set would be delayed without providing a new deadline, some CIOs said that the move threatened to throw their expensive implementation plans off track. In a recent survey, senior healthcare executives said that a one-year delay would be costly but manageable, while a longer hiatus would be "catastrophic."

The College of Healthcare Information Management Executives (CHIME) was particularly vocal about the problems that the lack of a definite time frame had produced. In a letter in February to the U.S. Department of Health & Human Services, CHIME President and CEO Richard Correll said the initial delay announcement "created a level of uncertainty that threatens much of the progress already made by many hospitals and clinics across the country."

CHIME is relieved that CMS has finally proposed a new deadline. In an interview with FierceHealthIT, Albert Oriol, CIO of Rady Children's Hospital in San Diego and a member of CHIME's policy steering committee, said, "It's good that we have a target to shoot for. Having that new target allows those of us who are in relatively decent shape [on the ICD-10 transition] to see what things can be slowed down to focus on other priorities, and where we need to keep the pedal to the metal to make a better use of our resources."

As for hospitals that were unsure whether they could meet the original deadline, he said, "This announcement relieves us from the uncertainty and gives us something to work toward."

Similarly, a spokesperson for the American Hospital Association called the announcement "welcome news," for smaller hospitals, in particular.

Physician reaction was less ebullient. In a statement issued Monday, American Medical Association President Peter W. Carmel said that the AMA "and physicians across the nation appreciate that CMS has proposed delaying the ICD-10 implementation date to October 1, 2014. The postponement is the first of many steps that regulators need to take to reduce the number of costly, time-consuming regulatory burdens that physicians are shouldering."

The Medical Group Management Association (MGMA), representing physician practice administrators, has said that CMS should not move forward with ICD-10 until it reforms the process of implementing regulations that affect the whole industry. Robert Tennant, senior policy advisor to MGMA, reiterated that position.

"One year is helpful, but in another year's time, we're going to be in the same boat," he told FierceHealthIT. "We need to change the process, not just extend the time."

The problem, Tennant said, is that not only physician practices, but also their partners--including software vendors, clearinghouses, and payers--need to be ready for ICD-10 when the switch is turned on. That wasn't the case in January, he noted, when providers were supposed to starting using the 5010 transaction set. As a result, many physician claims were not paid.

MGMA wants ICD-10 certification of practice management system vendors, which are not covered entities under the HIPAA law and so are not legally required to upgrade their software to accommodate ICD-10. "At least with a voluntary certification process, physician practices would be armed with the knowledge of whether or not their system would handle the code set," Tennant said.

Clearinghouses, which are covered entities, should also be certified for their ability to handle transactions involving ICD-10 claims, he said. The Affordable Care Act, he noted, already requires health plans to comply with HIPAA's administrative simplification requirements. "We feel that that could easily be extended out to include clearinghouses," he said.

Lynne Thomas Gordon, CEO of the American Health Information Management Association (AHIMA), said in a statement that despite her organization's preference for no delay at all, it is pleased with the decision to "keep the extension to essentially the shortest period possible."

Added Thomas Gordon: "We are empathetic to the pressures many small providers and practices have meeting the current requirements, but a continued delay and uncertainty in the implementation date is in no one's best interest."

To learn more:
- read the CMS announcement
- check out the proposed regulation
- here's the AMA's response to the proposal
- here's AHIMA's statement on the matter