Updated on: March 14, 2016

ICD-10 Delay Linked to Politics, but Keep the Momentum Going

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Original story posted on: May 19, 2014

The majority of us in healthcare were a little shocked by the political events in the latter part of March that once again delayed implementation of the ICD-10 code set. Let’s take a look at how the delay occurred and what it means to some of us, as the politics are pretty amazing.

 

The move was tied to a last-minute effort to get the temporary bill HR 4302, Protecting Access to Medicare Act of 2014, passed. The primary function of the legislation was to address the sustainable growth rate (SGR) formula, which is a budget cap first passed into law back in 1997 to control physician spending. Keep in mind that the SGR patch prevented a 24 percent cut to physicians’ Medicare payments.

Since 2003, Congress has instituted short-term patches to avoid unsustainable cuts imposed by the SGR. The most recent patch was set to expire on March 31, 2014, so there was a great deal of activity and bargaining occurring on Capitol Hill. Most legislators could not agree on how to pay for a permanent fix, and bipartisan negotiations led to a one-year patch to extend into 2015. The American Medical Association (AMA), American College of Physicians, American College of Surgeons, American Osteopathic Association, and American Academy of Family Physicians all opposed another patch and wanted a permanent solution. The delay of ICD-10 implementation was introduced as a “carrot” in Section 212 of the bill, along with several other provisions, to appease opposition and to get the legislation passed before a March 31, 2014 deadline.

In the House of Representatives, the bill was placed on the “suspension calendar,” meaning there was a temporary halt to the rules typically used to debate and pass measures on the floor. This provision can be invoked on Mondays, Tuesdays, Wednesdays, and the last six days of any session. Speaker of the House John Boehner (R-Ohio) determines which suspension motions the House will consider.

There are no floor amendments to such a bill required. However, the representative who offers a suspension motion may include amendments to the bill.

After a representative moves to suspend the rules and pass a particular measure, there can be 40 minutes of debate. At the end of the 40 minutes, the House casts a single vote on suspending the rules and passing the measure. There is no separate vote on the measure or on any amendments. Each suspension motion requires a vote of two-thirds of the members present and voting, assuming a quorum is present. This is different from a “roll call” vote, which many of us are familiar with, as such a vote requires a simple majority of 218 and is recorded electronically. In this case there is a voice vote; to conduct a voice vote the House chair determines the result on a comparison of the volume of “ayes” and “nays”. If any member requests a recorded vote and that request is supported by at least one-fifth of a quorum of the House, the vote is taken electronically and individually.

In the House of Representatives on March 27, a series of unusual events occurred very swiftly. At 11:32 a.m., Boehner announced that there would be a recess and that the next meeting would be subject to the call of the chair. Understandably, most members of the House left the floor. At 12:07 p.m., the House was called to return to session. A minute later, HR 4302 was declared unfinished business, and a minute after that there was a voice vote taken to pass the bill. Washington experts say there were enough opposition votes to the legislation (and the portion added introducing another ICD-10 delay) to halt the bill from moving forward. Yet representatives were not afforded enough time to return to the House and to be present for the voice vote to do so.

According to Washington insiders, it became clear to Republican and Democratic leadership that there were not enough votes to win a two-thirds majority for the SGR patch, so the vote was changed to a voice vote instead. The vote was scheduled to take place when the House chamber was nearly empty due to the recess. Boehner and House Minority Leader Nancy Pelosi (D-Calif.) both agreed to the process. Afterwards, Rep. Louie Gohmert (R-Texas) called the tactic "outrageous" and reportedly said that "now I know that I need to get with some other members and make sure we have people on the floor, since we won't be sure what our own leadership is going to do"(per The Hill).

Although there were more than 10,000 calls and emails placed to many members of the House of Representatives and to the Senate to rally against the SGR fix due to the inclusion of the ICD-10 delay, the above account describes the unforgettable story. As we know, the Senate subsequently passed a companion bill 64-35 and then President Obama signed the bill into law on April 1, 2014. Who suggested and actually wrote this ICD-10 section to be included in the bill is unclear. There is only speculation that special interest groups lobbied behind closed doors, and no one is coming forward to claim credit – at least not as of yet.

The language in Section 212 of the bill reads as follows: “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d-2(c)) and section 162.1002 of title 45, Code of Federal Regulations.” The Centers for Medicare & Medicaid Services (CMS) since has released information indicating that it is targeting October 2015 as the new implementation date and that there will be an interim rule published soon.

The impact of this delay is fairly significant to the healthcare industry. There have been four-plus years of planning and work already accomplished in many areas and settings of the industry, from information technology to health information management (HIM) and coding.

There are projected to be additional costs associated with this additional delay, which not only slows the advancement of healthcare modernization, but negatively impacts patient care, safety, and clinical research of public health data that was set to be implemented in October of this year.

The American Health Information Management Association (AHIMA) estimates that this delay will cost upward of $6 billion and stifle advancements in healthcare infrastructure, technology, and practice.

There are those who now are suggesting slowing things down, those who are saying we must continue to move forward, and yes, still a few who say we should not have ICD-10 at all. From reading recent articles and having conversations with many healthcare IT industry leaders, health information management professionals, and healthcare finance experts, I have found that the majority are in favor of continuing momentum and to keep moving forward with some sort of timeline expansion.

In summary, having politics seep into a nationwide implementation of a new disease and procedure classification system represents a previously unforeseen twist. Knowing the details, however, helps us understand the need to act as a voice and advocate for advancing our healthcare system to a much-improved way of doing things.

We would be well-advised to pay close attention to the political environment as it pertains to healthcare while we continue to keep retaining momentum toward quality information and quality healthcare.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICd-10-CM/PCS Trainer, is a 40-year HIM coding professional, focusing on compliance and ethics. She is a member of the ICD10monitor editorial board, and a popular panelist on Talk Ten Tuesdays.