June 23, 2014

All Eyes on Texas

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New York Yankees legend Yogi Berra once coined a phrase that seems to fit our present situation: “It’s déjà vu all over again!”

The political fastball that none of us saw coming was whacked out of the proverbial ballpark a few weeks ago, with the implementation date of ICD-10 having been smacked clear into 2015. All I can say at this point is, “wow,” and wonder if even that date is realistic.

It seemed that all the forces were lined up to make 2014 really happen. The Centers for Medicare & Medicaid Services (CMS) was hard-lining the date, as was the American Medical Association (AMA), the American Health Information Management Association (AHIMA), as well as a cadre of other politically formidable organizations. We trainers were sticking to our guns too (although the savvy ones were allowing themselves some wiggle room).

What lessons can we learn from this latest postponement? Can we examine the events leading up to it and learn something from it? I think we can, and after taking a look in the rearview mirror, I have found at least two areas I will monitor more closely as I try to predict the future timeline of the ICD-10 implementation.

As the October 2014 date approached, I was impressed by the blustery tone of the rhetoric coming from CMS regarding their certainty and commitment to that date. When the rollout of healthcare.gov turned out to be such an embarrassing debacle, for which Kathleen Sebelius claimed ultimate responsibility, it briefly crossed my mind that Congress might take heed and impose a delay. However, I did not see, in the current climate of political gridlock, that the parties would come together to take up the gauntlet on a relatively unknown and unromantic issue like ICD-10. However, I forgot about the SGR, or sustainable growth rate. 

The SGR is an unworkable formula for balancing the Medicare budget that was enacted in 1997. Implementation of the SGR would mean serious reductions in reimbursement for providers and facilities. Soon after the Balanced Budget Act of 1997 established the SGR, healthcare providers began lobbying Congress annually, predicting dire consequences in patient care and healthcare availability should the SGR be imposed. Accordingly, each year since its inception, Congress has postponed implementation of the SGR. This compounded cost of this annual delay means that now, in order to meet statutory mandates, if implemented today the SGR would lead to the slashing of all Medicare reimbursement by more than 24 percent. This figure is clearly unsustainable, and implementation at this level would bring about the total collapse of our healthcare system.

So, what does the SGR have to do with ICD-10? Well, the “fix” for the SGR is going to have to entail some painful and politically unappetizing budget cuts and restrictions to access to healthcare. Therefore, it is not surprising that both parties have failed to step up and propose an acceptable solution to the SGR dilemma.

Until Congress has the courage to permanently fix the SGR, it is doomed to postpone it annually, a la the 1993 film “Groundhog Day.” Resultantly, for the last 17 years, Congress has annually passed a major healthcare bill, amendment, or proviso to address the SGR. This process ensures that there will be passage of an annual healthcare bill. This also will provide an opportunity, each year, to appease the healthcare provider industry by inserting ICD-10 postponement language, which is exactly what happened a few weeks ago.

Moving forward, I plan on watching the legislative process leading up to the annual SGR postponement much more closely. Monitoring the pulse of provider groups as the SGR legislation approaches will help predict the future of ICD-10, as Congress has shown the ability to be swayed on the issue. This observation leads to another area worth monitoring, and one that is in my own backyard!

I am a bit chagrined about this next area to monitor, because I should have seen it coming. You see, I am a Texas physician. Why is that significant? Well, it was the Texas delegation to the American Medical Association (AMA) that raised the ire of the rank-and-file AMA membership and compelled the association to change its pro-CMS stance on ICD-10 in 2012.

The AMA was able to flex enough muscle to convince Congress to extend implementation to 2014. And that is where we all thought it would end. 

However, in the summer of 2013, the Texas Medical Association (TMA) made it known that it opposed the 2014 deadline. Not enough time for physicians to prepare, they said. Furthermore, they contended that adoption in 2014 would be too disruptive to practices, and with the advent of “Obamacare,” too many changes were being implemented too quickly. While in agreement, I completely underestimated the ability of the champions of Texas medicine to get their way. I am not privy to the wheelings and dealings of the smoke-filled chambers of Washington, D.C., but no one will convince me that the recent outcome was not the direct result of pressure brought to bear by the defenders of medicine in Texas.

So, all of us in the ICD-10 preparation industry have a little egg on our face. I’m sporting a little more egg than most, because I did not anticipate the effectiveness of the fervor expressed by my colleagues here in Texas. We can all try to learn from the past delays and direct more attention on those areas that are likely to impact the decision to implement ICD-10.

Moving forward, I will have a two-pronged plan to track the implementation timeline. First, I will pay closer attention to the annual march of the SGR delay through Congress. Second, and most importantly, I will keep my ear tuned in to what the Texas medical organizations are saying with regard to ICD-10.

On this issue, it appears that, as Texas goes, so goes the rest of the nation!

About the Author

Stephen C. Spain, MD, CPC, is a family physician with more than 30 years of patient care experience.  He currently serves as Physician Advisor to Career Step and, as such, informs their ICD-10 provider documentation education and presents the introduction to the Career Step online overview module, ICD-10: Understanding its Purpose and Value.  In 1998, Dr. Spain founded Doc-U-Chart, a consulting firm that helps medical professionals improve their understanding and application of documentation and coding principles. 

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The opinions expressed in this article are the author's own and do not necessarily reflect the view of the ICD10monitor.

Dr. Stephen Spain, MD, CPC

Stephen C. Spain, MD, CPC, is a family physician with more than 30 years of patient care experience.  He currently serves as Physician Advisor to Career Step and, as such, informs their ICD-10 provider documentation education and presents the introduction to the Career Step online overview module, ICD-10: Understanding its Purpose and Value.  In 1998, Dr. Spain founded Doc-U-Chart, a consulting firm that helps medical professionals improve their understanding and application of documentation and coding principles.

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