May 19, 2014

CMS Official Denise Buenning Resigns, Albright Steps Up

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WASHINGTON, D.C. — CMS official Denise Buenning, whose rallying call last month that “the delay is not a killer for ICD-10” ignited healthcare’s social media universe, has stepped down from her post to take a position with nonprofit CAQH, an association of health plans and trade associations.

 

Although rumors of her exit started circulating last week, on Saturday a CMS spokesperson confirmed for ICD10monitor that Buenning, deputy director for the CMS Office of E-health Standards & Services, had resigned earlier in the month. The same source said that Matthew Albright will take over Buenning’s role.

A spokesperson for CAQH confirmed that Buenning reported for work last week as the director for its committee on operating rules for information exchanges (CORE) initiatives. She will report to Gwendolyn Lohse, the CORE director.

Buenning was a popular and sought-after speaker at conferences held by professional associations such as the American Health Information Management Association (AHIMA). During the association’s recent meeting in Washington, D.C., she told members that the delay of ICD-10 passed by Congress on March 31 and signed into law in April was “not a killer of ICD-10.”

Until last week, when CMS announced its intention to name October 2015 as the new deadline for the implementation of ICD-10 in an interim final rule, the agency had been silent about the delay. Buenning’s remarks at the April 23 AHIMA meeting marked the first public statement by anyone from CMS since the law had gone into effect.

During her prepared remarks, Buenning acknowledged that the congressional vote to delay ICD-10 implementation was a surprise.

“I think we were as surprised as all of you,” Buenning told the audience, admitting that the vote by Congress “(has) been hard for all of us at CMS.”

A 17-year veteran of CMS, Buenning was witness to a number of setbacks that have now become emblematic of the healthcare industry’s inability to adopt ICD-10. The most recent of these, most notably, was the U.S. Senate vote on a much-watched piece of legislation that, while intended to prevent cuts of Medicare physician payments under the contentious sustainable growth rate (SGR), included language delaying ICD-10 adoption until next year.

ICD-10: A Journey of Delays

The ongoing delays of ICD-10 adoption have been a recurring challenge for Buenning. Rumors of an earlier delay of ICD-10 were on her mind back in May 2011, when, during a national provider teleconference on CMS, Buenning told listeners that rumors “flying around (about the delay) don’t hold water.”

At the time, Buenning emphasized that CMS was “working toward” the implementation date of Oct. 1, 2013, noting that the agency formed a steering committee and that staff were “now into the nitty-gritty” of the transition.

During a Dec. 13, 2011 radio roundtable produced by ICD10monitor’s Talk Ten Tuesday, Buenning was characteristically resolute. During the panel discussion, Buenning said that "nothing has changed at CMS relative to ICD-10 implementation” and that “we haven't been given any clue that the implementation date will move.”

“In fact,” Buenning added, CMS has developed “more traction on ICD-10.”

And in a moment of foreshadowing, during the broadcast she added that “the notion that Congress could enact a postponement or complete halt to the implementation of ICD-10 boggles the mind.”

Self-Imposed Delay

Rumblings of a possible delay gained traction later that year, in November 2011, when the American Medical Association's (AMA) House of Delegates voted “to work vigorously to stop implementation" of ICD-10. What followed was a letter-writing campaign that continued through February of this year.

"The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients' care," AMA's then-president Peter W. Carmel, MD, said during the meeting. “At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions.”

Following up, in January 2012AMA Executive Vice President and CEO James Madara wrote  a letter to House Speaker John Boehner citing “significant burdens on the practice of medicine with no direct benefit to individual patient care.” Madara was urging Congress to stop the implementation of ICD-10 mandated for all HIPAA-covered entities by October 2013.

Then in February 2012, then-acting CMS Administrator Marilyn Tavenner told members of the AMA that the agency would reexamine the timeline for transitioning from ICD-9 to ICD-10. Two days later, the U.S. Department of Health and Human Services (HHS) announced that it would initiate the rulemaking process to postpone the date for implementation of the new code set. HHS Secretary Kathleen G. Sebelius, in a news release issued on Wednesday, Feb. 15, said the agency had heard from “many in the provider community who have concerns about the administrative burdens they face in the years ahead.”

Today, CMS faces a number of continuing challenges associated with ICD-10, including the release of an interim final rule that will include a new compliance date requiring the use of ICD-10 beginning Oct. 1, 2015.

“CMS loses more institutional history and expertise,” Stanley Nachimson said in commenting on Buenning’s departure. “Their  (CMS’s) HIPAA organization is overwhelmed right now with a number of major initiatives – ICD-10, health plan certification, health plan ID, claims attachment standards – and can ill afford to lose experienced staff.”

Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.