ICD-10 Delayed Again

Yesterday, the Senate passed H.R. 4302, Protecting Access to Medicare Act of 2014 which puts another band-aid on the Medicare payment rate and delays the implementation of ICD-10 by at least a year. President Obama is expected to sign this bill into law. There are mixed reviews regarding this bill for several reasons. Medicare providers will once again take a short-term breath of relief over payment rates as will all organizations and health care providers who have not sufficiently prepared for the ICD-10 implementation. However, patches of this magnitude are costly.

SGR Needs to be Repealed

In the last 11 years, the Medicare payment rate has been 'fixed' 17 times due to the SGR formula. According to an article in Califormia Healthline, "Since 2003, Congress has spent nearly $150 billion on short-term patches to stave off Medicare payment cuts scheduled under the SGR formula." Just last month, it seemed that this flawed formula might finally be repealed, however, this didn't happen. So when H.R. 4302 came along, the American Medical Association and nearly 90 other organizations voiced their strong opposition. Although avoiding the SGR cut is good, many people, including congressional leaders take issue with the way that this bill was introduced and then passed with only a voice vote.

ICD-10 Delay Implications

The timing of this bill is interesting because a month ago, Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner definitively stated at the Health Information and Management Systems Society (HIMSS) 2014 Annual Conference that there would be no more ICD-10 delays. So why this last minute legislative halt? The answer to that billion dollar question can best be answered by the congressional leaders involved in the drafting of H.R. 4302. The American Health Information Management Association (AHIMA) suggested that "the insertion of the ICD-10 delay section into H.R. 4302 was likely done to placate physicians who are against an SGR patch. The AMA has said they are against moving to ICD-10 entirely."

When it comes to financial costs, according to AHIMA, "CMS estimates that a one year delay could cost between $1 billion to $6.6 billion." That hefty price tag does not include the costs already incurred by healthcare providers, vendors and other organizations who have been preparing for ICD-10 for the last several years. However, the costs of delaying ICD-10 are not just monetary. We also need to consider:

• Lost momentum: Those who have been ramping up and preparing will have to hold off again. It seems probable that procrastinators will continue to hope for additional delays and will continue to avoid ICD-10 preparation even with a longer time frame.
• Frozen code sets: ICD-9-CM has been frozen for several years now. This leads to problems of adequately reporting changes and data comparision on a global scale.

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