Electronic Health Reporter

ICD-10 has been delayed. Change has been left unchanged. The can has been kicked down the road by politicians in Washington, despite a great deal of opposition from those in healthcare. Of course, opposition to the delay seemed to matter little as it was voted upon, and passed, as part of the broader SGR patch.

Athenahealth, one of the better known vendor names in the health IT landscape issued the following statement in reaction to the news of the delay of ICD-10 for another year to October 2015. Ed Park, executive vice president and chief operating officer, athenahealth, said: “It is unfortunate that the government has once again chosen to delay ICD-10. athenahealth and its clients are/were prepared for the ICD-10 transition, and in fact we have national payer data showing that 78 percent of payers are currently proving readiness in line with the 2014 deadline. The moving goal line is a significant distraction to providers and inappropriately invokes massive additional investments of time and money for all. The issue is even more serious when considered in association with another short-term SGR fix and 2013’s meaningful use Stage 2 delay. It is alarmingly clear that healthcare is operating in an environment where there is no penalty for not being able to keep pace with necessary steps and deadlines to move health care forward. Our system is already woefully behind in embracing technology to drive information quality, data exchange, and efficiency, and delays like this only hinder us further.”

Sharp words, but appropriate. It’s nice to see a vendor come out and speak some truth, at least as they see it. Despite the somewhat shocking and seemingly inappropriate delay of ICD-10, it’s clear the waiting will continue for the new deadline.

Athenahealth is not alone. Others feel similarly about the delay. The following are responses from several healthcare practitioners and their partners about the ICD-10 delay. They provide some interesting insight about the move from October 1, 2014, to 2015 and express disappointment and, in some cases, anger about the postponement.

Michele Hibbert-Iaccobacci, vice president of information management and support, Mitchell International

ICD-8 was not an industry standard, so when ICD-9 was introduced, it was a huge undertaking to try and get people trained. For the ICD-10 transition, we have a current standard to work with. The real roadblock for many are the intricacies of ICD-10 because despite all the preparation training you go through, if you don’t have an anatomy and physiology background, it’s going to be a lot harder. I can understand why then, the compliance date would be pushed back but with all the time the industry has spent talking about ICD-10, there are so many resources and educational materials by now that are readily available to healthcare entities. The 2014 ICD-10 compliance date was actually very realistic and attainable with the proper resources.

What’s more confusing in this scenario, is the fact that non-covered entities including property and casualty insurance health plans and worker’s compensation programs, along with others, have started to switch to ICD-10 codes in effort to seamlessly align with the rest of the industry. It’d be a mess if the vendor or partner you were using wasn’t prepared. So now there’s a disconnect. Half of the industry is prepared, half isn’t. There will always be bumps in the road when you’re talking about an entire industry switching to a new language, but a bit of tough love would have done the industry good here. Now we’ll see more time, more energy and more resources go to waste.

Michelle Leavitt, director, courseware and product strategy, HealthcareSource

A delay in ICD-10 implementation – coming just six months out from the planned implementation deadline – is a disaster for the industry. We are finally starting to see broad traction with the switch – most polls are showing the majority of organizations have started and many are well on their way to completion – which means that most organizations have already invested significant time, money, and resources in preparing for this switch and are in the middle of or about to begin the most intense part of that process.  It is impossible to put those plans on ice for another year without significant cost.  A delay also doesn’t bode well for government-industry relations. CMS administrators promised just last month at the HIMSS conference that there would be no delays, so the message a last-minute delay sends is that CMS can’t be trusted. It also discourages early adoption of government programs. From an employee education perspective, which is where my work has focused, the longer the time between providing education on a topic and using it, the less useful the education. A delay in the ICD-10 implementation date will push out coders’ utilization of their new knowledge, which means that all the organizations that implemented education programs on time in 2013, 2012, or even earlier will have to reinvest time and money into additional education programs to bridge the time gap between when that initial education was provided and a delayed implementation date.

Response from MedSys Group:

“Delaying ICD-10 is a superficial strategy to attempt to vent the regulatory “pressure cooker” healthcare finds itself in. The bill on the floor was distributed for review only 24 hours prior to the vote. While it’s readily apparent providers are under inordinate amounts of pressure to meet the regulatory mandates firing off beginning with ICD-10, a more holistic approach is needed to isolate the appropriate action and make reasonable, logical decisions that keep the goal of the regulatory changes in mind. Instead of “delaying ICD-10” — we should consider a dual reporting period that would allow organizations to catch up, both technically and operationally — and allow the focused data collection (one of the core objectives of ICD-10) to proceed without interruption. In concert, a broader evaluation of the entire regulatory environment — as a whole — needs to occur from the provider point of view to determine a workable framework to support the challenges organizations are facing technically, operationally and, ultimately, financially. The pressure of ICD-10, combined with meaningful use, SGR, National Patient Safety Goals, CMS Quality Measures, ARRA/HIPAA expansion … it’s becoming a job just to keep track of meeting the requirements — and that is NOT the goal. The goal is to improve healthcare; a holistic review and development of a realistic timeline including all regulatory due dates would be a smarter move.”  — Nancy Miracle, senior strategic advisor

“Delaying ICD-10 was the right thing to do two years ago. Delaying it by a year right now is an excellent idea. Killing it altogether would be even better. There is no articulable value to a provider or a patient that comes from ICD-10. It’s a billing/coding vocabulary poorly suited to clinical care, just like ICD-9. The details are arcane and difficult to penetrate. The vocabulary is poorly aligned to the science of clinical medicine. And as far as patients go, the esoteric minutiae of this coding system are going to have to be systematically hidden far, far away to keep from confusing them utterly. Payors may benefit temporarily by finding new ways to deny or minimize payment, but in a world where shared risk and population health are the priorities, word games at this level push in exactly the wrong direction.. The expense and effort put forth in this area would be far better devoted to improving care, sharing risk, eliminating fee-for-service perverse incentives, and improving the health of our population. ICD-10 has nothing to do with any of this. Congress would be well advised to pass the extant measure and to consider whether it might make even more sense to abandon ICD-10 entirely.” — Dick Taylor, chief medical officer and managing director

David McMullan, PT, vice president of product management, therapy division, SourceMedical

From a pure vendor perspective, we are torn by the one-year delay for ICD-10. We are ready and prepared for the October 1, 2014, implementation date. On the other hand, we are acutely aware that the majority of providers in outpatient rehabilitation would respond with a collective “Hooray” if there is a delay because of lack of testing and their low comfort level with payers and CMS’s preparedness. If this delay until 2015 goes into effect, I am afraid the majority of healthcare providers will put this on the back burner until next year; just like they did when it got delayed to 2014. From a more global perspective, the industry needs to make this transition to ICD-10 for many reasons, the most important of which is the healthcare and safety of the American patient population. We are so far behind the times with respect to disease management and our ability to leverage data to provide critical information for improved quality of care and clinical decision making. We would not even be discussing this delay if this was not an election year in November.

David Jeter, MPT, CMPT, Acceleration Physical Therapy

The only value of ICD-10 is for insurance companies and the government to acquire more information about specific diagnoses and mechanisms of injury/acquisition. There are no benefits to the delivery of healthcare from a provider standpoint, and it will create another layer of paperwork. For offices like mine, who still use paper charts, it will continue to be a problem. EHR programs are automatically programed to add G-Codes for physical therapy, but we have to look them up for each evaluation or re-evaluation. At this point, I have memorized the standard 30 or so ICD-9 codes that I use on a daily basis.  I may have to look one up per day or every other day. With ICD-10, from a functional standpoint, I will have to look up several codes each time I perform an evaluation. ICD-10 will also have the added benefit for insurance companies to deny claims that they deem some other party to be responsible for. Who’s house were you at? Were you intoxicated? I can’t imagine that there will be a huge push back from providers, as we continue to take on more paperwork, more pre-authorization, more treatment dictated by insurance companies, but it does get old. It makes providing healthcare a lot less fun than it should be.

Jennifer Searfoss, J.D., C.M.P.E., chief executive officer, Searfoss Consulting Group

The majority of my clients are opposed to this delay. My clients include small and medium sized physician groups. Basically, everyone feels that we know that ICD-10 is a reality so just get it over with. Any delay means that there is less pressure on our venders to get the upgrades done.

Then there are others who feel that there is just too much going on right now and a delay is the right thing to do. For those folks, I ask: When EVER will be a good time? The answer is never. I urged all my clients to call their Senators today.

Ben Quirk, president, Quirk Healthcare Solutions

We’re in the midst of a perfect storm of government initiatives in 2014, from meaningful use deadlines and Medicare cuts to the Affordable Care Act. For practices having to deal with a host of new programs and their financial impacts, the recent passage of an ICD-10 extension is a good thing. But for the industry as a whole, it comes too late. Delays and procrastination have become the norm, from 5010 to HIPAA to MU hardships. This makes it difficult or impossible to plan.

Providers and their vendors are in a constant state of flux, which is detrimental not only to provider practices but also to the patients they serve. This is why organizations such as the American Health Information Management Association (AHIMA) came out strongly against the ICD-10 delay. Many providers and their vendors have made enormous investments to meet the existing deadline.

In addition, delay will cause setbacks in information-based initiatives such as patient-centered medical homes and value-based purchasing. It will also have an effect on more than 25,000 students in associate and Bachelor’s degree programs who have learned to code exclusively in ICD-10.

Still, it is hard to ignore the magnitude of the disruption that would have occurred if this year’s ICD-10 mandate had remained in place. Providers would have taken a significant financial hit, and patients would have seen an increase in improperly denied claims. That’s why the AMA has consistently lobbied against ICD-10, although they were opposed to the legislation that just passed because it lacked a permanent repeal of SGA cuts.

To sum it up: ICD-10 delay at this point is a good tactic, but part of a bad strategy. If we are going to change the entire landscape of healthcare, let’s do the sensible thing and spread    it out over a period of years, not a period of months.

Response from Kareo

Kareo, a technology vendor in healthcare IT, has been working diligently to prepare our products, staff, systems and medical practice customers for the October 1 transition to ICD-10. We are not specifically for or against the new coding system – our objective is to ensure we can effectively support our customers as they work to comply with a variety of government programs, rules, and regulations.

Our ability to support the success of our medical practice customers, however, is negatively impacted when the regulated environment in which we, and our customers operate, is constantly in flux. Managing in a constantly changing environment wastes valuable time and resources, ultimately leading to higher healthcare costs and less focus on what’s most important – the patient.

As we pursue our mission to deliver technology solutions to simplify the lives of physicians and their staff, we require regulatory clarity so that we can deliver the value we promise our medical practice customers. We’re here to help but need more stability to deliver to our potential.

The healthcare industry must demand that the government commit to a schedule for something as substantial as ICD-10 and stick with it. The impact to budgets and productivity are too great and the risk of inaction over the next 12 months is substantial.

CMS estimates that a one-year delay of ICD-10 will cost the system between $1 billion and $6 billion. This is approximately 10 percent to 30 percent of what has already been invested by providers, payers, vendors and academic programs.

“As a technology company serving small medical practices, our goal is to simplify everything our customers do so that their focus is where it should be — on patients, not paperwork,” said Dan Rodrigues, CEO and founder at Kareo. “This goal will be difficult to achieve unless all stakeholders have a clear understanding of the true timeline and requirements of major government mandates.”

“This delay will be hard on physicians and practice staff who, over the last year, put forth a significant effort and investment to prepare themselves for the ICD-10 transition,” said Dr. Tom Giannulli, chief medical information officer at Kareo. “We are now looking for clear direction so that we can confidently prepare our company and customers for this significant transition.”

“If ICD-10 is to become a reality, we agree with CMS administrators that it’s time to commit to a schedule,” said Rob Pickell, chief marketing officer at Kareo. “While we understand the concerns of our customers over making this major change successfully, we fear the worst scenario is a never-ending series of delays leading to vendor, payer and practice inaction.”