CMS hints at delay in ICD-10 implementation deadline

HCPRO Website, February 14, 2012

UPDATED: February 15, 12:24 p.m.

By Andrea Kraynak, CPC

Big news regarding the ICD-10-CM/PCS implementation timeline came out this morning during the American Medical Association (AMA) National Advocacy Conference in Washington, DC.

Per CMS acting administrator Marilyn Tavenner, CMS plans to revisit the current implementation deadline of October 1, 2013. Tavenner said CMS wants to reexamine the pace of implementing ICD-10 and reduce physicians’ administrative burden, according to an AMA tweet from this morning.

Tavenner also indicated that the timeline will be revisited through the rulemaking process, according to Modern Healthcare, which CMS has since confirmed to HCPro.

CMS told HCPro that it expects to release additional information at later this afternoon.

“Since the AMA announced its intention to try and delay the implementation of ICD-10, this news does not come as a total surprise,” said Lynne Spryszak, RN, CCDS, CPC-A, clinical documentation improvement (CDI) education director for HCPro, Inc., in Danvers, MA. “Providers are expected to comply with meaningful use, transition their practices to the 5010, and implement EHRs in their office. When you consider that providers are also facing a decrease in their reimbursement rates it is no wonder that they feel that their backs are against the wall.”

That said, providers have had plenty of advance notice, Spryszak noted. CMS announced the conversion to ICD-10 in January of 2009, giving them nearly five years to plan.

The American Hospital Association (AHA) supports the transition to ICD-10 but welcomes reevaluation of the deadline.

“The AHA appreciates CMS’ willingness to reconsider the timeline for ICD 10 implementation,” Chantal Worzala, director of policy for AHA, told HCPro. “The AHA is supportive of the move to ICD-10 because it brings benefits for better clinical documentation, logical incorporation of codes for new technologies, and greater specificity to support accurate payment. However, changes in the environment that have occurred since ICD-10 was mandated for October 2013, including meaningful use, are putting significant pressures on hospitals. Implementing ICD-10 on schedule requires that the transition to 5010 go smoothly. It also requires that all parties be ready. We are closely tracking readiness of vendors and providers to implement ICD-10.”

Tavenner indicated CMS plans to formally announce plans for new regulations in the coming days, according to an article by The Hill. Tavenner recognizes the concern that providers are balancing many different initiatives. "So we're trying to listen to that and be responsive," she said, per the article.

Until further information becomes available on the exact nature of the delay, providers should continue to push forward with their implementation efforts, according to industry experts.

“Even if they do delay ICD-10, especially for physician practices, this should not deter the infrastructure redevelopment to accommodate ICD-10’s likely implementation in whatever time frame they do implement it, be it six, 12, 18, or 24 months from their previously announced date of October 1, 2013,” said James S. Kennedy, MD, CCS, managing director of FTI Consulting in Brentwood, TN.

Mixed reactions

News of the potential delay is being met with diverse reactions.

“The provider population is just coming off the preparation efforts for 5010, so a slight delay may be appropriate,” said Rose T. Dunn, MBA, RHIA, CPA, FACHE, chief operating officer at First Class Solutions, Inc. in Maryland Heights, MO. However, the delay should not be excessive, she said. Those proactive providers that have ICD-10 preparations well underway should be able to “get on” with their other activities, as they have a number of competing priorities right now.

The reaction by the physician community is to be expected: “There will be much rejoicing...” said Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta. He believes that the physicians lack the tools they need for the transition. “If a tool were there that spoke clinical language and was available as an app on a smart phone or a tablet and would intercommunicate with the hospital and the physicians' offices, there would be no problem in meeting the existing deadline. Without this, it's dead in the water.”

Meanwhile, as Kennedy explained, the rest of the world is already using ICD-10 and will likely transition to ICD-11 soon, while the United States is still using ICD-9. “Change is necessary if we are to develop a robust database of our patients' illnesses and treatments as to better measure outcomes and efficiency. While ICD-10 is not perfect—nothing is—we should not let the need for perfection be the enemy of the common good. Procrastination is not the solution,” he said.

Jennifer Avery, CCS, CPC-H, CPC, CPC-I, regulatory specialist for HCPro, Inc, agreed. “I think it would be a tragedy to delay the process any further because we are so far behind the ball now that it is going to be even more difficult playing catch up.” She too noted that until the move to ICD-10 is complete, there will be ongoing problems because the ICD-9 system is insufficient. “ICD-9 codes just don’t work when it comes to reporting our diagnoses and procedures [for inpatients] and we need the added specificity,” she says.

And of course, there are financial considerations. Many organizations have already invested huge dollars preparing.

“Providers and payers have done extensive work and spent millions to get ready for implementation, from training to systems issues, data conversions, budget considerations, staffing, etc. To put this major transition on hold will not only have a negative financial impact on what has already been done and create a major setback when we need to start up again, it will also add a mental blow when implementation comes around again—it feels a little like the boy who cried wolf!” explained Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro.

Mackaman said that those professionals and providers with whom she has spoken are looking ahead to the transition, recognizing that the benefits of moving forward—from data that will assist with improved patient care to improved statistical reporting and payment—far outweigh the advantages of stalling.

"At a certain point you begin to wonder why we don’t just wait until ICD-11," said Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding, at HCPro. She too questioned the decision to delay so late in the game after providers have already invested in assessments and revised systems.

In a February 14 press release, AHIMA stated its concern over the “turmoil”  and recommends that CMS “make clear that the industry should not halt its progress on ICD-10 implementation while the timeline is being reexamined."
“This is a promise from CMS to examine the timeline, not to change it,” Dan Rode, MBA, CHPS, FHFMA, vice president for advocacy and policy at AHIMA, said in the press release. “But government officials are sending mixed signals that many in the healthcare community will interpret as a reason for delay. This concerns AHIMA and our constituents, as 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 (HHS) programs, including Meaningful Use.”

The AAPC was still formulating comments at the time of publication.