Timing is everything. On St. Patrick's Day, I wrote a blog about the sobering fact that there were less than 200 days left until the October 1 ICD-10 implementation deadline and that healthcare providers under the gun could be forgiven for indulging in drink. Now, a few weeks later, a crush of events in Washington have turned the ICD-10 compliance deadline on its head, leaving all of us with more questions than answers, particularly concerning what the process will be going forward.

We've been down this road before. This is the second time in nearly two years that the ICD-10 compliance date has been pushed back. However, this time it's Congress, not the Centers for Medicare and Medicaid Services, pulling the trigger. Something feels very different this time around. I know, with the extension of ICD-10 to at least October 2015, the American Medical Association says doctors will now have "much-needed extra year" to prepare for the code switchover. Yet, knowing that human nature is to procrastinate, it doesn't give me any comfort.

Looking at the events of the past week, I feel awful in particular for organizations that have prepared for the previous ICD-10 deadline and invested significant time, money and resources towards the transition, only to now put those preparations on hold. That can't be easy. Not surprisingly, industry groups like the American Health Information Management Association and College of Healthcare Information Management Executives have been outspoken critics of the ICD-10 implementation delay that became law on April 1 when President Obama signed legislation passed by the House and Senate.

AHIMA held an April 4 webinar to help its members understand the legislative process that led to the ICD-10 delay and to discuss the organization's next steps. Margarita Valdez, AHIMA's director of congressional relations, said that the ICD-10 delay provision was added to H.R. 4302, the Protecting Access to Medicare Act of 2014, as a "carrot to appease" physician and specialty medical groups, such as AMA, American College of Physicians, and American College of Surgeons, to get them to agree to another temporary patch to the Medicare Sustainable Growth Rate formula.

Valdez noted that lawmakers, working with physician groups, have tried to add amendments to legislation to delay ICD-10 "for quite some time and this has not just been specific to SGR." In all these past instances, AHIMA has been able to keep the legislative language delaying ICD-10 out of appropriations bills and other proposed legislation, she said. However, this time, faced with fast-track legislation based on a bipartisan deal between Senate Majority Leader Harry Reid and House Speaker John Boehner, the political odds were stacked against AHIMA and other groups trying to prevent congressional approval of an ICD-10 delay.

AHIMA argues that another one-year delay of ICD-10 will likely cost the healthcare industry an additional $1 billion to $6.6 billion on top of the already incurred costs from the previous delay--figures that the organization said do not include the lost opportunity costs of failing to move to a more effective code set. The Protecting Access to Medicare Act of 2014 states that the Department of Health and Human Services cannot adopt the ICD-10 code set as the standard “until at least” October 1, 2015. AHIMA is currently seeking clarification on a number of technical issues including the exact length of the delay. However, CMS has not yet responded to AHIMA's request for information.

On the other end of the spectrum, AMA says the ICD-10 delay will relieve physicians of the "crushing administrative burdens and practice disruptions" that would have resulted from the October 1, 2014 deadline. However, not everyone is in agreement with the AMA's position on the delay.

"This move to delay ICD-10 really has a negative impact on our practice," stated a comment posted on the AMA website. "For our practice, we have spent serious time and money in preparation for this change. We have our software upgraded to support ICD-10 and have been testing this with all our systems. Now, we have to delay to wait for those that were not as prepared…We are canceling training and putting all our processes on hold and will have to restart this process again next year at this time."

Incredibly, some people are actually suggesting that we should forget about ICD-10 and wait for ICD-11, which has been pushed out to 2017 when it will go before the World Health Assembly. As a country, our leaders need to stop kicking the can down the road, whether we are talking about the national debt, entitlement programs, or the SGR formula. During the Senate debate about the "doc fix" bill, Senator Tom Coburn (R-Okla.) mocked the idea of temporary SGR patches with a sign that read: “Put Off Until Tomorrow What You Should Be Doing Today.” It's time to stop the madness.  

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