Who Will Throw up The White Flag First?
It has been going on longer than the Twenty-Year War that began in 1475. The World Health Organization (WHO) released in 1993 the International Classification of Diseases, Tenth Edition (ICD-10). Shortly thereafter, the Healthcare Financing Administration (now the Centers for Medicare and Medicaid Services (CMS)) began moving forward to prepare for its implementation it in the United States (U.S.). Like the Twenty-Year War and many others bravely fought throughout history, the ICD-10 conflict has really consisted of a lot of little battles, which are, or will be, subsumed as one in the archives.
A year ago the healthcare industry was reeling from the unexpected delay to the implementation of ICD-10. The surprise attack, which brought on the last minute change in the implementation date, was slipped into legislation to provide a temporary patch to the sustainable growth rate (SGR) and passed within a few days, without ample time for the other side to rally their troops. While this hurdle was difficult for advocates of ICD-10 to deal with, it had followed many previous small battles to permanently disarm the change to ICD-10.
The significant backlash from physicians’ groups and organized medicine had successfully challenged, the Health and Human Services (HHS) October 1, 2011 proposed an implementation date to replace ICD-9-CM with ICD-10-CM and ICD-10 PCS. The transition dealine was first pushed back to an October 1, 2013 deadline for adoption. By 2012, the well-funded opposition again forced the deadline to be moved, from October 1, 2013 to October 1, 2014. That battle was followed by The Protecting Access to Medicare Act of 2014, the last minute emergency legislation to provide relief from the SGR. This bill, which contained a provision prohibiting the HHS Secretary from adopting the ICD-10 code prior to October 1, 2015.
Politicians and Presidents from the Oval office to the boardroom of every healthcare organization in the U.S., including the American Medical Association (AMA), the American Hospital Association (AHA), the Medical Group Management Association (MGMA) and the American Health Information Management Association (AHIMA) have remained entrenched to protect, or attack, the October 1, 2015 implementation deadline. In short, the ICD-10’s implementation has been a long, dramatic timeline and one that is, unfortunately, still being contested on the Congressional battlefield.
Despite the “firmness” asserted by CMS of the October 1, 2015 date, the road to the implementation deadline has not been unscathed in 2015. On June 9th, the House of Representatives introduced a bill to allow a two-year ICD-10 “grace period” to help physicians and healthcare providers more effortlessly transition from ICD-9 into ICD-10. Representative Gary Palmer in proposing the bill—Protecting Patients and Physicians Against Coding Act of 2015, H.R. 2652—indicated the intention was to smooth out the code submission process for ICD-10-CM/PCS. The bill calls upon the Secretary of HHS to provide for a two-year grace period during which physicians and other health care providers submitting claims and other documents using ICD-10 to Medicare and Medicaid are not penalized for errors, mistakes, and malfunctions relating to the transition to such a code set.
This is the third ICD-10 related bill introduced into the House within the past five weeks. Early in May, the House proposed a new bill, H.R. 2126, the Cutting Costly Codes Act of 2015, aimed at freezing ICD-10 CM/PCS implementation. The bill, strongly supported by the AMA, intends to prohibit Sylvia M. Burwell, Secretary of HHS, from substituting the currently implemented ICD-9 diagnostic code set with ICD-10. H.R. 2126 additionally mandates the Government Accountability Office (GAO) to execute research on how to best alleviate the financial burden of this decision on healthcare providers. AMA President, Steven J. Stack responding to last year’s implementation delay said, “While the AMA appreciates that physicians have additional time to comply with ICD-10, we continue to have fundamental concerns about ICD-10 and its implementation, which will not be resolved by the extra time. The AMA has long considered ICD-10 to be a massive unfunded mandate that comes at a time when physicians are trying to meet several other federal technology requirements and risk penalties if they fail to do so.”1 A 2014 update of a widely referenced 2008 report by Nachimson Advisors to the AMA estimated the cost for a small practice to implement ICD-10 was in the range of $22,560 to $105,506.2
In direct opposition to the 2014 “controversial” delay and any additional delays in 2015, the AHIMA blasted the AMA cost estimates of ICD-10 implementation. Coming in with a substantially lower cost, the AHIMA research shows a price tag of $1,960 to $5,900 for small practices. Accordingly, AHIMA found that the current evidence suggests that the AMA estimates of the costs and effort associated with ICD-10 implementation for physician offices has been overestimated and that vendors, health plans and physicians have made considerable progress with fewer resources than had been previously estimated.3
It also follows the House’s proposal of the Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-10 bill), H.R.2247 intended to mandate Sylvia M. Burwell, Secretary of the Department of Health and Human Services, to implement additional transparent testing opportunities. The bill sponsored by Representative Black, requires the Secretary to conduct and make available to all participating service providers and suppliers, a comprehensive, end-to-end testing process to assess whether the Medicare fee-for-service claims processing system based on the ICD-10 standard is fully functioning. The Secretary must subsequently certify to Congress whether or not the Medicare fee-for-service claims processing system based on the ICD-10 standard is fully functioning, including additional steps a not-fully-functioning system will take to achieve certification as well as the anticipated time frame for achieving it.4
It has been 16 years since the U.S. version of ICD-10 was completed and five years since publication of the ICD-10 final rule. Every implementation delay has caused providers disruptions, confusion and for many, a lack of trust with CMS and Congress. None of the aforementioned congressional actions address the significant cost the industry has absorbed due to numerous delays of ICD-10. CMS has estimated that the 2014 delay, enacted on April 1 through a legislative act of Congress, has cost the healthcare industry approximately $6.8 billion in lost investments, not including the cost associated with missed opportunities for better health data to improve quality of care and patient safety.
It is difficult to estimate the overall costs incurred by the U.S. Government, payers, providers and vendors throughout the past decade. It’s likely to have exceeded $50 billion, however no one really knows for sure.
As of press time, we are still on track for ICD-10 implementation in October. The transition from ICD-9 to ICD-10 has been fraught with frustrations. Those that seek to delay or permanently kill off the ICD-10 implementation have not yet waved a white flag. Both sides have their armies of advocates and sponsors ready to be heard on Capitol Hill.
To that end, on June 18th the nation’s four largest state medical societies, collectively, the California Medical Association, Florida Medical Association, Medical Society of the State of New York, and Texas Medical Association have written to Andy Slavitt, the Acting Administrator Centers for Medicare & Medicaid Services to ask for help in modifying the ICD-10 transition to reflect the following changes:
– A two-year period during which physicians will not be penalized for errors, mistakes, and/or
malfunctions of the system;
– A two-year period in which physicians will not be subject to RAC audits related to ICD-10
– A two-year period during which physician payments will not be reduced or withheld based
on ICD-10 coding mistakes; and
– Advance payments in the event that claims are delayed.
Whether you see yourself or your organization as a champion or a conqueror regarding ICD-10, it is likely both sides will need to “bend the knee” to the reality of a whole new world of healthcare challenges; many far more serious and potentially expensive than the twenty-plus years required to resolve one small piece of the U.S. healthcare industry.
View this article and others at Miramedgs.com
Phil C. Solomon is the publisher of Revenue Cycle News, a healthcare business information blog. He serves as the Vice President of Global Services for MiraMed, a global healthcare Business Processing Outsourcing services company. Phil has 25 years of experience in healthcare as an industry thought leader, strategist, solution provider, author and featured speaker. In this blog, you will read about important industry updates, strategies for improving financial performance, and commentary that challenges the status quo.