ICD-10 Delay Doesn’t Address Procedural Hurdles, Critics Say

Update From HealthLeaders Media Dated April 10, 2012

The federal government’s proposed rule that would delay for one year the implementation date for ICD-10 buys providers more time but does nothing to address underlying procedural problems that could wreak havoc when the diagnostic code set eventual goes live, one observer says.

“Yes, an additional year is going to be helpful. But it doesn’t solve the underlying flaws in the current process,” says Robert Tennant, senior policy advisor with Medical Group Management Association.

“Additional time only gets us to where we are now a year later. Our position all along has been the process itself is flawed. They never did a pilot. We need staggered implementation dates to build in the specific testing period.”

If finalized, the one-year delay, detailed in CMS’s proposed rule, means that ICD-10 standard would become effective Oct. 1, 2014.

“Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date,” HHS said in an April 9 press release . “The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.”

Federal officials had hinted in February that a delay was in the making, so the news Monday did not surprise key provider groups that had raised concerns about the pace of implementation.

“The American Medical Association and physicians across the nation appreciate that CMS has proposed delaying the ICD-10 implementation date to Oct. 1, 2014,” AMA President Peter W. Carmel, MD, said in a media release. “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.”

Carmel said the AMA is still reviewing the proposed rule and plans to issue formal comments to CMS on the delayed ICD-10deadline, “as well as the standard unique health plan identifier proposed in the same rule. A robust unique health plan identifier is an administrative simplification solution that has the potential to bring about significant cost-savings by eliminating the ambiguity that makes health care transactions so costly today,” Carmel said.

Marie Watteau, director of media relations for the American Hospital Association, told HealthLeaders Media in an email exchange that HHS’s announcement was “welcome news, especially for smaller hospitals. The AHA will continue to work closely with all of our members to support ICD-10 implementation.”

Tennant says the federal government’s “debacle” with 510(k) implementation demonstrates that everyone in healthcare “can’t be vectoring toward the same compliance date.”

“There has to be a way to get the plans and clearing houses ahead of time and then bring the providers on and have a period of time where there is testing and then you go live after the testing has taken place,” he says. “This is not just about ICD-10. There are a whole host of mandates coming out of the Affordable Care Act, and if we don’t improve the process we are going to be running into roadblocks at every turn.”

“Also we as providers are so reliant on our software vendors and those folks, the practice management systems vendors, are not covered entities under HIPAA,” he says. “What we would like to see happen is a certification process so there would be some guarantee that the software could handle the new codes and so we are going to be advocating for that.”

MGMA’s Tennant says he’s not convinced that ICD-10 is needed in physician practices and he complained about “a lot of misinformation” on ICD-10 implementation from advocates for the code set.

“The standard line is we are the last country on earth to use this code set when the truth is no country uses this code set,” he says. “The main countries that are cited, Germany, Australia and Canada, none of these three implement ICD-10 on the physician side. They only did it on the hospital side. I think the jury is still out on whether or not it is appropriate even to implement it on the physician side. There has to be more study done.”