CMS Silence on ICD-10 Holds Healthcare Hostage

CMS Administrator Marilyn Tavenner firmly vowed only weeks ago that there would be no ICD-10 delay. Now that an undefined delay has been announced, she remains silent on ICD-10's next steps.

The hives-inducing Washington, DC-based drama, ICD-10 Held Hostage, has entered its second week.

This first week has been good news for a variety of FUDbusters and others hawking products meant to cut through the fear, uncertainty and doubt following the stealthy legislative blitz that delayed CMS's requirement for providers to use ICD-10 starting October 1.

One Webinar was subtitled, "What changes? What doesn't?"

The answer is, no one outside of CMS knows yet.

You read that right.

The first thing that needs to change is CMS's ICD-10 landing page, which as of noon Tuesday still stated that the ICD-10 code set would replace ICD-9 "on October 1, 2014." How has this not been updated yet?

It is the height of something or other that CMS Administrator Marilyn Tavenner, who at HIMSS so firmly vowed there would be no ICD-10 delay, remains silent on ICD-10's next steps. Yet somehow, she found time last week to proclaim April National Minority Health Month, a purely ceremonial proclamation.

For Hospital CFOs, ICD-10 Delay a Costly Disappointment

The fact is that here in week two, providers of all races, creeds and colors are in a bit of a panic about how to proceed on ICD-10. The language of the SGR fix legislation only states that ICD-10 won't commence earlier than October 1, 2015.

That leaves the open-ended possibility, for the moment, that for some inscrutable reason, CMS could opt to select a new cutover date later than October 1, 2015. The mere possibility of this has the entire healthcare IT industry trapped in a kind of limbo.

That is not good for ICD-10 or for healthcare.

For further perspective, last week I spoke with two consultants who advise providers on ICD-10-related matters.

It Gets Worse
The first reminded me that healthcare providers have set their upgrade and implementation schedules around the October 2014 schedule. But they are also at the mercy of software vendors who have planned to release upgrades to their programs in bundles.

Software does not respect neat boundaries between things programmed to implement ICD-10 and other enhancements, so the possibility exists that software vendors are prepared to deliver new versions of all sorts of systems this year that have ICD-10 implemented by default.

Those same software vendors are expecting providers to honor contracts they have signed to pay for and accept software that implements ICD-10 this year, not next year.

The news just gets worse. "Every expert in the industry has been advising people to do more than just treat this as a software upgrade, because there were, or there are, potential business benefits to be gained, but only if you actually embed ICD-10 coding into your business processes," says Jordan Battani, who runs a think tank on regulatory changes and trends for Computer Sciences Corporation, a systems integrator.

How long will it take CMS to figure out its part? "I don't know," Battani told me, "and I'm really glad I don't work there this week."

Another consultant, like Battani, is urging his provider clients to pause, take stock of their ICD-10 efforts, and redeploy resources to more pressing tasks if possible, until CMS has weighed in.

"A lot of the clinical documentation in ICD-9 was not all accurate," says Fletcher Lance, national healthcare leader and vice president of global consulting firm North Highland. "There was about a 20, 25 percent error rate there, so we're encouraging clients to go back and work on that, and protect that revenue and get the coding right in this interim period as a very practical step as something to do while we learn more from CMS."

A Silver Lining #JustKidding
In the midst of all this uncertainty, on the eve of April Fools' Day, former ONC head Farzad Mostashari tweeted, "Only silver lining to the #ICD10delays? Putting to bed the over-used 'perfect storm' mantra."

But after talking to Battani and Lance, this just looks like an extended hurricane season for healthcare IT.

"I don't know how much experience you have with doing very big projects, but it's very hard to slow them down and stay effective and focused and hit a revised deadline," Battani told me.

"In some ways it's almost easier when you're doing a big project when it's just cancelled. Then you just dismantle all the apparatus and you move on to other things, but the challenge that these organizations will be facing now is how to maintain organizational focus and be ready to ramp up again when the new deadline is disclosed, and that sort of start/stop, continue activity is very, very difficult to optimize."

Battani also threw cold water on a strategy by which some providers would code to ICD-10 in the fall and then back-code to ICD-9 to continue to get paid.

"Here's the thing about payment," Battani said. "There's a lot of reimbursement schemes in ICD-9. When you're forced to use not-very-specific diagnosis information, those claims require additional documentation to be submitted in order to get paid. That's a process that's incompletely automated, so there are problems in the reimbursement process that ICD-10 is a useful tool for helping to fix, streamline, and optimize payment."

In addition, "whenever you're using crosswalks, that creates another opportunity for appeals and disputes about reimbursements, because there's endless argument about did you crosswalk it to the right thing," that's the case even going from ICD-10 back to ICD-9, Battani added.

Small Shops Beware
Why do I get the feeling that eventually, the very members of Congress who voted for this delay will be pounding the table demanding to know what HHS is going to do about this newest healthcare crisis, a crisis of their own making that failed to get a single mention on the floor of the House or the Senate, or in the President's statement upon signing?

My final thought this week comes from author Michael Lewis, who has written a book about high frequency trading in the financial markets. Jon Stewart interviewed Lewis about questionable, tech-powered high-speed trading on Wall Street last week. "Larger firms dine off regulation," Lewis noted.

My fear for healthcare is that the extended hurricane season that is now ICD-10 will be only the latest of many threats to community hospitals and small practices. Only the large firms, which have the deepest pockets and the most resources, and are most agile at adapting to changing deadlines, are likely to survive this continued onslaught. Meanwhile, CMS still has a Web site to update.