Last week, President Obama signed a bill postponing the ICD-10 deadline until October 1, 2015 at the earliest, leaving providers wondering how to respond.
Though many providers appealed to CMS to slow things down again—the original deadline was in 2013—the agency said repeatedly that it was not going to back down on this year's deadline.
But CMS had not counted on the intervention of Congress. Now the industry is left wondering what steps to take next, having already collectively invested hundreds of millions of dollars to prepare to meet the previous deadline, notes Modern Healthcare.
So, what happens next? Industry reactions have been mixed. While the delay in the ICD-10 deadline is welcome for many, providers still have a massive task ahead of them to scale up from 13,000 codes under ICD-9 to the 68,000 codes that make up ICD-10. And those who have already begun the transition in earnest are left not only with sunk costs, but also with uncertainty about when (and if) ICD-10 will come online for real.
AMA still dissatisfied
The organization perhaps most opposed to the ICD-10 rollout—the American Medical Association—has had a lukewarm reaction to the announcement at best.
You'd think its leaders would be celebrating. After all, the trade group is predicting that ICD-10 will cost its members a fortune: The AMA has estimated that it would cost $56,630 to $226,105 for a typical small practice to implement the code set in 2014; $213,364 to $824,735 for a typical medium-sized practice; and $2,017,151 to $8,018,364 for a typical large practice.
Not only that, medical practices generally weren't ready to move ahead, Betsy Nicoletti, founder of Codapedia.com and the author of "A Field Guide to Physician Coding," told Physicians Practice magazine. "Large health systems and hospitals were prepared, but many physician practices lagged behind," Nicoletti said.
The AMA’s opposition, however, is primarily political. While the AMA has taken a public stance of being "vigorously opposed" to implementing ICD-10, the delay in implementation comes with another temporary patch to the Sustainable Growth Rate, which would have cut physician Medicare payments 24% as of April 1st. The AMA has been fighting for a permanent fix to the SGR dilemma for many years, without success.
"The AMA and other physician organizations strongly agree that while a delay in ICD-10 implementation provides welcome temporary relief, it does not offset the continued harm caused by keeping the SGR formula on life support and further delaying badly needed Medicare physician payment reforms," AMA president Ardis Dee Hoven, MD, told Healthcare IT News.
Impact on hospitals
While many physician practices simply weren’t ready—and whether for financial or cultural reasons aren’t likely to be ready whenever new coding is implemented—many large hospital systems had invested considerable resources in planning, training, budgeting, and coding in advance of the October 1 deadline.
All of these strategies will need to be revisited in preparation for the new deadline, said Terrance Govender, a director in the health care practice consulting firm Navigant. "This, unfortunately, will have a costly impact on these hospitals, and it will be important for them to once again budget accordingly," Govender said.
Some executives at hospitals and insurance companies are left wondering whether they should continue "dual-coding" efforts. To prepare for the ICD-10 switch, many hospitals have spent large amounts of time and money to code procedures in both code sets, then audit the ICD-10 side to see if it's accurate. Some hospitals may slow their implementation processes, but they don’t plan on halting it entirely. As reported in Modern Healthcare, Beth Israel Deaconess will go forward with “as much ICD-10 as possible,” including dual-coding—using ICD-10 data in-house and ICD-9 for billing.
"Too many investments in time and money have gone on in this one to just say 'nope, not doing it,'" Roger Neal, VP and CIO at Duncan (Okla.) Regional Hospital, told FierceHealthIT.
Another outside possibility that hospitals and physicians alike may have to contend with is that legislators may choose to bypass ICD-10 entirely and jump straight to ICD-11. No official announcement has been made, but the World Health Organization fact sheet states that "the 11th revision process is underway and the final ICD-11 will be released in 2017."
As of Monday afternoon, CMS had not released any further guidance or information. According to a statement from spokeswoman Rachel Maisler late last week, the agency is examining the legislation and guidance is forthcoming. In the meantime, providers will have to prognosticate as best they can in an uncertain environment.