Congress Kicks the Can Down the Road; Delays ICD-10 for One Year

Editor’s Note: The Medicare “doc fix” has been finalized and the SGR problem has been resolved. Additionally, ICS-10 was final in October 2015. The following article is being provided for historical perspective purposes.

Congress voted to institute a 1-year “doc fix” preventing a 24% pay cut for physicians who treat Medicare patients. This is the 17th patch in 11 years whereby Congress delayed the “doc fix.”  Although there was strong bipartisan support in both the House and Senate to repeal the Sustainable Growth Rate (SGR) formula responsible for the problem, the doc fix was enacted again.  President Obama signed into law the Protecting Access to Medicare Act of 2014 on April 1, 2014.

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Protecting Access To Medicare Act

The law takes the 0.5 percent increase in fees that went into effect in Medicare from January 1, 2014, through March 31, 2014, and extends it from April 1, 2014, through December 31, 2014. It also provides a zero percent increase to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015.  So instead of fixing the problem, they again delayed, kicking the can down the road for others to fix. Each time, the extension took place in the past, physicians and patients were told that this time, things would be different; that the temporary patch would give Congress the time it needs to achieve agreement on permanent reform. Although talking points told us that this would be the year they fixed the problem, the faulty SGR formula stands and nothing happens.  Thus, Congress again kicked the can down the road for others to fix it.

Meanwhile, the Protecting Access to Medicare Act of 2014 signed by President Obama also delayed the implementation of the International Classification of Diseases, 10th Revision (ICD-10), from October 1, 2014, to October 1, 2015.  The American Medical Association (AMA), the American Academy of Family Physicians (AAFP), and Medical Group Management Association favored the delay of the codes because they were worried the healthcare industry would not be ready by the October 1, 2014 deadline.  Polls showed that only 60% of the healthcare industry was ready for the ICD-10 implementation.  It is interesting to note that the October 1, 2014 date represented a one-year delay from the initial implementation date of October 1, 2013.

Loss of Income

The new form of diagnostic codes represents advances in medicine, global data reporting, and expansion of the specificity of the codes. The World Health Organization (WHO) oversees the implementation of ICD-10. WHO is ready to roll out ICD-11.  The AMA’s 2014 study estimates that the implementation of the new ICD-10 diagnostic codes could result in an initial loss to small practices from $56,639 to $226,105.¹ The majority of the initial loss in income is projected to occur because doctors, staff and health plans would not be ready by October 1, 2014. Meanwhile, the rest of the world has already implemented ICD-10. Great Britain for example, instituted ICD-10 in 1995.  The only country lagging behind in the implementation is the United States.

The American Health Information Management Association (AHIMA) supported the upgrade to ICD-10 in 2014. In its online newsletter, it said, “another delay in ICD-10 will cost the industry money and wasted time implementing the new code set.”²  The health system in the United States has kicked the ICD can down the road for others to fix it.

What Will Happen in Doctor’s Offices Throughout the Country?

Once President Obama signed the delay on April 1, 2014, we quickly realized that this was no April fool’s joke.  The dynamics were interesting because societies, doctors, their staff and other entities immediately relaxed! Almost immediately cancellations of webinars and classes occurred. After all, we have another year!  One office even told me they clapped when they heard legislation was passed to delay ICD-10. Now they could just relax and not worry about it.

While some offices are ready, we know the delay may be helpful to other providers to make sure they are ready for this huge change. If given another year, this offers an opportunity to increase your readiness through proactive education, practice, and testing. The postponement allows improvement of anatomical knowledge needed for the new codes, review, and adjustment of documentation quality and clinician education, and alteration of coding and billing procedures.

Don’t Procrastinate

If you decide to use the delay to just sit back and relax, then you are just as guilty of kicking the can down the road as Congress and other factions.  Procrastination of actions needed for the ICD-10 implementation will result in doctors, staff, billing companies and insurance companies scrambling again next year.

The change to the ICD-10 system will require upgrades of your software, training of you and your staff and a conversion to the codes you most commonly use in your practice. Most of the conversions of the codes from ICD-9 to ICD-10 cannot be done for you. Preparation will lead to success.

If you need another year, then this change offers the opportunity to increase your readiness through education, upgrades, practice, and testing. The postponement allows improvement of knowledge, review of procedures and adjustment of documentation quality and coding and billing procedures.  The time to prepare is now and not to kick the can down the road!

1.  The Cost of Implementing ICD‐10 for Physician Practices – Updating the 2008  Nachimson Advisors Study A Report to the American Medical Association 

http://www.ama-assn.org/resources/doc/washington/icd-10-costs-for-physician-practices-study.pdf

2.  “Congress to Vote on ICD-10 Delay Tomorrow, AHIMA Calls for Action to Stop Bill Today”, Mar 26, 2014, Journal of AHIMA, http://journal.ahima.org/2014/03/26/congress-voting-tomorrow-on-icd-10-delay-ahima-calls-on-members-to-take-action/