Possible ICD-10 Delay Nets Widespread Physician Support

Signals that federal officials might "re-examine the pace" of next year's implementation dates for ICD-10 are bringing mostly favorable reactions from healthcare providers. [Update: delay has been confirmed.]

Marilyn Tavenner, acting administrator for the Centers for Medicare & Medicaid Services, told an American Medical Association conference in Washington, DC on Tuesday that the federal government was sympathetic to physicians' concerns about the Oct. 1, 2013 implementation date for the new standard of diagnostic classification.

"I'm committing today to work with you to reexamine the pace at which we implement ICD-10," Tavenner said as a room full of doctors applauded, according to a post from the Massachusetts Medical Society. "I want to work together to ensure that we implement ICD-10 in a way that (meets its) goals while recognizing your concerns."

Tavenner made no specific promises at the AMA event, but she said CMS may soon issue a statement on the topic in the coming days or weeks.

For months AMA and other physicians' associations have called for a delay of the implementation date, saying that the switch from the old ICD-9 system to the far more granular ICD-10 represents an unfunded mandate that could cost medical practices between $82,000 and $2.7 million to install.

In November, the AMA's house of delegates voted to "vigorously work to stop the implementation" of the "onerous" implementation of ICD-10."

Those financial pressures, AMA said, come as physicians are also coping with:

• the switch to mandated electronic medical records;
• the transition to 5010 HIPAA transaction standards;
• confusion over the requirements—and legal status—of the Affordable Care Act;
• the push for Accountable Care Organizations, patient-centered medical homes, bundled payments, and other new care and compensation models;
• the unsettled status of Sustainable Growth Rate funding in the Medicare "doc fix"   

AMA President-elect, Jeremy A. Lazarus, MD, said in a statement Tuesday that the nation's largest physicians' organization "welcomes the opportunity to discuss ICD-10 implementation, along with many overlapping regulatory requirements that are burdening physician practices."

"The AMA appreciates that Ms. Tavenner and the administration have heard our concerns and have recognized the significant challenges and burdens ICD-10 implementation will create on the practice of medicine, and that they are committed to reviewing the pace of implementation," Lazarus said.

Pam McNutt, CIO and senior vice president at Methodist Health System in Dallas, TX, told HealthLeaders Media that providers are simply overwhelmed by the federal mandates raining down on their heads.

"All of that is happening in the same timeframe and they are all interwoven. It really seems like it is almost too much, especially when you think about it from the physicians' perspective," McNutt says.

"There are so many physicians who we need to move along the path of getting on to electronic health records. Now we are adding this burden. Plus you hear about budget cuts that are going to affect physicians and hospitals reimbursements. So the timing just doesn't seem right to be piling on all of these initiatives."

McNutt says she believes the ICD-10 implementation should be delayed until 2015 "to give ACOs, bundled payment models, and Meaningful Use Stage 2, a chance to gel. To me that would be ideal."

However, Wendy Whittington, MD,  CMO at Dallas-based HIT provider  Anthelio Healthcare Solutions called any effort to delay ICD-10 implementation "a bad idea."

"How can organizations be good at strategic planning if the rules keep changing," Whittington says. "A lot of proponents of putting this off are citing the fact that we are all too busy with meaningful use to deal with ICD-10. I see that as exactly the reason why we should take the deadline seriously."

"When you are thoughtful about strategic planning and you do things the right way and not just to collect the incentives you may have already been incorporating where ICD-10 is going to fit into all of this," she says. "Really, what we are doing by changing the rules mid-game is punishing those who have been thoughtfully been thinking through how to do this."

The possibility of a delay also concerns leadership at the American Health Information Management Association. In a statement issued Tuesday, AHIMA's vice president for advocacy and policy, Dan Rode, said, "any delay in the transition preparation for ICD-10 will both increase actual costs and may diminish the value of other Health and Human Services programs, including Meaningful Use.”

For the most part, however, hospital CIOs who spoke with HealthLeaders Media say they support the delay.

Mike Smith, CIO at Lee Memorial Health System, in Fort Meyers, FL says healthcare providers and the federal government should have learned the lesson from the rush to implementation of the 5010 HIPAA transaction standards. 

"I think if we just observe with the 5010 implementation that these changes can have long-lived and unintended consequences," Smith says. "The ICD-10 schedule was established before meaningful use was even a thought. We just have a lot of things compressed at one time. For the best interests of patient safety and trying to handle things in an orderly fashion, it would be best for the industry that it be delayed a bit. There are a lot of good things with ICD-10 but still if you try to do too much too fast you are going to have negative unintended consequences."

Randy McCleese, CIO at St. Claire Regional Medical Center in Morehead, KY says his hospital just isn't ready to make the switch. "ICD-10 definitely gives us a more granular approach that we need, but coming from a small rural hospital, we are just now putting the things in place that will allow us to get to that depth of detail," McCleese says. "I'd like to see it delayed two years. That would help tremendously."

Robert Tennant, senior policy advisor with Medical Group Management Association, says the problem isn't the implementation date, but the implementation process.

"It's not a question of pushing it back a year or two. It's the process itself. We have gone through this before with HIPAA 4010, and now 5010. There has to be a better way," he says.

"We have been consistently over the years asking CMS to institute a pilot test to identify correctly what the benefits and the costs will be to the industry, especially to physician practices, to identify an intelligent pathway forward for any change, and to recognize that this might require some financial assistance for physician practices," Tennant said.

"And we have consistently said that we should not move forward with ICD-10 until 5010 was fully in place. The 5010 process has not gone particularly well. They are already in contingency mode and 5010 is a tiny percentage of the challenge that physician practices will face moving to ICD-10."

McNutt and Smith say that finding and training ICD-10 coders may prove to be the biggest hurdle for providers in a compressed timeframe.

"The medical records coder implementations are significant. It's not clear how significant, but you hear numbers like 25%-50% reduction in productivity," Smith says. "That means we are going to have to come up with a lot of coders in the next 18 months, not only training the ones you have on ICD-10 but additional capacity. The longer we wait the better chance we will have for more advanced automated coding assist tools to help with that transition." 

Whittington says that the AMA and other groups that want to delay the implementation date are using overheated rhetoric and motivated by "their own selfish interest and not the best interest of moving healthcare in the nation forward as a whole."

"Calling this an 'unfunded mandate' is a harsh statement because the rest of the developed world is already on ICD-10," she says. "We have known about this change for years. ICD-9 was designed in the 1970s. So it's not like this is an 'all of a sudden we have to do this' thing. It's moving to a system that will work better for us."