April 1, 2014 – In a shocking move, both the House and Senate have voted to postpone ICD-10 until at least Oct. 1, 2015, marking the second time ICD-10 has been delayed. The House passed the bill last week and the Senate approved it yesterday evening, without a single debate about ICD-10 in either chamber of Congress because all the contentious volleying was focused squarely on the sustainable growth rate (SGR) formula. Now all that’s left is for President Obama to sign the bill into law. Industry groups are reeling from the news and have expressed great disappointment. Sounds like a bad April Fools’ Day joke, right?
H.R. 4302, the Protecting Access to Medicare Act of 2014, a.k.a. the Doc Fix bill, is highly controversial because it’s merely a quick fix that will inevitably fall short of providing a permanent solution. While it suspended Medicare’s troubled sustainable growth rate (SGR) formula for a year, thereby protecting seniors’ access to physicians, it’s not the comprehensive SGR reform that was needed and will end up costing more money in the long run. This will be the 17th patch to the SGR formula, which would have reduced providers’ Medicare payments by a whopping 24%. Something had to be done, but the last-minute cramming of this inadequate bill shows just how out of touch Congress is with the inner workings of the healthcare industry. And burying the ICD-10 delay provision? Now that was sneaky.
Although the ICD-10 delay will be a welcomed relief for those running behind, including payers, providers, clearinghouses, and even core claims system vendors, it’s severely penalizing those who have already invested heavily in the implementation and testing of the new code set. Healthcare payers who were already on track for the 2014 ICD-10 go live may choose to continue on as planned in what will be a “soft rollout,” accepting ICD-10 codes from the providers that have transitioned. But they will also have to accept ICD-9 claims for an additional year. Or payers can put ICD-10 on hold and wait another year, which would likely necessitate retraining their staff and a huge shift of resources. AHIMA estimated that this delay will cost the industry an additional $1 billion to $6.6 billion, not including costs from the first delay.
What’s even more disconcerting is that leading up to the passing of this bill, both CMS and the Obama Administration had been adamantly assuring the industry that ICD-10 would not be delayed again. Even at the February 25, 2014 HIMSS Conference, CMS Administrator Marilyn Tavenner guaranteed that ICD-10 wouldn’t be postponed. It seems as if even the top White House and CMS authorities were blindsided by this bill. A large coalition of industry groups including the AMA, AHIMA, CHIME, and ACHCI have spoken out against this bill, which has thrust the healthcare industry back into a state of uncertainty.