April 11, 2014

ICD-10 Challenges Await New HHS Secretary


With the healthcare industry already reeling from shock waves sent last week by the president signing legislation delaying the start of ICD-10 for at least one year, the announcement yesterday that Health and Human Services Secretary Kathleen Sebelius was stepping down after a five-year stint in the Obama Cabinet was another blow to the body.


President Obama is expected today to nominate Sylvia Mathews Burwell, director of the Office of Management and Budget (OMB), to replace the embattled secretary.

 If confirmed by the U.S. Senate, Burwell faces a myriad of challenges including the unfinished business resetting the implementation date of ICD-10—long a contentious issue that has sharply divided an industry that rarely has coalesced around controversial issues.

Sebelius’ stepping down was to be expected, according to those who monitor the vagaries of Washington. Against the backdrop of a country divided over the benefits of the Patient Protection and Affordable Care Act (ACA), Mr. Obama put a positive spin on his signature legislation with his announcement last week that enrollment in the healthcare exchange had surpassed 7 million, despite a fitful start of the program last fall.  

“Secretary Sebelius' resignation was not a question of if, but when,” Monitor Mondays legislative analyst Emily Evans wrote in an email to ICD10monitor. “The botched rollout of healthcare.gov means the secretary would find it difficult to get congressional support for other or new initiatives,” wrote Evans, who is a partner at Obsidian Research. “Her tenure, despite all the turmoil, ends on a high note,” Evan added.

While on her watch, Sebelius was witness to two successful drives to delay implementation of ICD-10. The secretary also became the face of Internet “end-to-end” testing.

Sebelius’ remarks last November during congressional hearings into the botched launch of the Obama administration’s website HealthCare.gov caught the attention of healthcare executives who at the time very much had end-to-end testing on their radar screens.

During a tense exchange between U.S. Rep. Joe Pitts, R-Pa.— sponsor of H.R. 4302, that ultimately delayed ICD-10—and Sebelius, Pitts asked the secretary if she believed two weeks of site testing before October 1 was "enough time." Sebelius responded "clearly not," further noting, “we did not adequately do end-to-end testing.”

Those remarks by the secretary gave ICD-10 stakeholders another reason to pounce on the Centers for Medicare & Medicaid Services (CMS). The issue of whether CMS would conduct end-to-end testing had been a speculatively contentious issue with those who had long held that the agency should not have abandoned its commitment to conduct end-to-end testing as it did in June 2013.

Then, last November, CMS announced that it would set aside the week of March 3-7, 2014, as ICD-10 Testing Week or, as it had become known, “acknowledgement testing.” More recently, in February of this year, CMS announced plans for limited ICD-10 testing to take place this summer.

With the delay of ICD-10, there is no indication at this time when or if testing will take place as originally announced. There has been no guidance from CMS for restarting ICD-10 implementation and there remains a great deal of unfinished work for the new secretary to address.

But the first order of business will be nomination hearings, all of which are expected to be contentious given that this is a political year and Republicans have fixated on repealing Obamacare as a major campaign strategy for the upcoming midterm elections. Democratic control of the U.S. Senate also appears to be in play.

Referring to the secretary’s exit, healthcare IT guru Stanley Nachimson, a former official with CMS, doesn’t think her departure will make a difference.

“While she has been a lightning rod for criticism and probably wants to take on other challenges,” wrote Nachimson in an email to ICD10monitor, “I do not expect the change in secretary to have any significant impact on the industry.”

And so it goes. Again.



Chuck Buck

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

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