How does one identify an incompetent government administration? When it consistently is the last entity to spot the obvious--time and time again--that is the measure of incompetence.

If you just take its missteps and propensity for denial in the health care industry and not count anything else during the past five years, the Obama Administration still proudly yet without a clue wears the crown of incompetence.

Under the electronic health records meaningful use program, the administration has repeatedly and belatedly made deadline and schedule changes and other tweaks to program provisions only when industry concerns reached alarming levels and it was late in the game. To their credit, the Office of the National Coordinator for HIT and Centers for Medicare and Medicaid Services have made these changes, mostly recently by offering a hardship exemption to meeting Stage 2 meaningful use in 2014. But as is regularly the case, it took forever for them to really understand what stakeholders understood long before.

And now comes ICD-10, with the nation’s health care payment system--which reform has already started tinkering with--in jeopardy.

CMS officials several times during HIMSS14 reminded attendees that the ICD-10 deadline won’t change. “And just to reiterate, the Oct. 1, 2014 compliance date for ICD-10 is a firm one, and you can quote me on that,” said Robert Tagalicod, director of CMS’ Office of E-Health Standards and Services. CMS Administrator Marilyn Tavenner went further during her HIMSS Keynote. She said that CMS began testing systems for ICD-10 in 2011 and as of October 2013, all systems were ready at CMS.

Sure, internal testing shows all systems are “go,” but Medicare and Medicaid haven’t tested WITH THE INDUSTRY. Even if the deadline remains, just about everyone knows there will there will have to be some sort of policy change--a grace period or dual-coding or some other tweak to keep the economics of health from collapsing. But you have to wonder if the government knows that.

Officials failed to grasp the obvious with health insurance exchanges and now they are failing again to grasp the obvious with the next BIG heath technology issue: ICD-10.

CMS is saying all systems are go for the code set when it hasn’t even conducted its one whole week of “acknowledgement” testing in March to make sure that contractors can ACCEPT claims coded in ICD-10. And CMS is saying all systems are go before conducting any end-to-end testing to make sure contractors can PAY claims. And CMS didn’t agree to end-to-end-testing until mid-February 2014, and the testing will be very limited and take place “sometime” during the summer only weeks or months from the deadline.

When a government agency that insures one-third of the nation says it is ready for fundamental change from reform and ICD-10, yet has proven it doesn’t really understand its readiness status for either change; that is the measure of incompetence. And when the Obama Administration keeps letting that agency act like a bunch of rookies in their 5th year in the big leagues; that is the truest measure of incompetence.

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