Updated on: March 16, 2016

Realities and Speculation Surround ICD-10’s Delay

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Original story posted on: August 22, 2012

“We’re at the mercy of the vendors and payers,” says Lyman Sornberger, executive director of revenue cycle management for the Cleveland Clinic Hospital System, “The Cleveland Clinic can’t drive the change [to ICD-10] without the other players taking it seriously as well, but luckily our payers have been very cooperative.”

 

Sornberger shared these and other insights on ICD Monitor’s August 21 Talk-Ten-Tuesday broadcastThe Fog of Ambiguity. Ian Bonnet, vice president of WellPoint, brought a payer’s perspective to the program, and Jeff Smith, assistant director of advocacy at the College of Healthcare Information Management Executives (CHIME), speculated how this election year might affect implementation. Denny Flint, the president of Complete Practice Resources, wrapped up the broadcast by calling the Centers for Medicare & Medicaid Services (CMS) “ironic,” noting that, in its bulletins to providers, CMS encourages that they be “clear and concise” in their transition actions, but the agency’s own actions are anything but that.

Burning the Midnight Oil

What’s keeping providers and payers up at night?  Bonnet and Sornberger agree that the number one concern surrounding the continued delay relates to their companies’ investments, which include not only money but also staff time and effort. Bonnet speaks for many when he says, “We’re definitely anxious to get the final rule,” but until then several issues will haunt healthcare leaders.

The final implementation date will determine how investments will fare. A delay of one year would be tolerable while a delay of two or more would not. Take, for example, the constantly changing field of information technology (IT). “In a dynamic world, the IT we’re using now won’t be relevant in the future when we pull it off the shelf,” said Bonnet.

An extended delay also will affect the people now working on the transition. “If it goes beyond 2014, across all segments, some people will be around, some won’t,” he said. “If it’s delayed until or beyond 2015, we may have to get a crop of new people and, in general, reassess our focus and our momentum.”

Sornberger agrees and adds, “At what point does everyone start to take a new date seriously? Cleveland Clinic is committed to an early adoption. Will the payers be as serious as we are? I think we’ll lose that audience if it goes further out.”

In spite of these concerns, those at Wellpoint and Cleveland Clinic are assuming that the compliance date will be 2014 and plan to stay on track—advice that Bonnet urges other providers and payers to follow. In fact, in response to the poll taken during the August 21 broadcast, 40 percent of survey responders stated they were on track and have made no revisions to their plans and 40 percent have slowed down a little. On the flip side, 10 percent have put everything on hold until the final rule comes out, 8 percent haven’t started on anything, and 1 percent plan on waiting even after the final rule is released.

Room for Speculation

Will everybody be happy if CMS delays ICD-10 compliance for two to four years? Probably not, and, as Smith says, “You’ll find some segment will want further delay, which sets up an interesting dynamic.” Part of the dynamic is the fact that this is an election year, and the political party in control of the presidency, the U.S. House of Representatives, and U.S. Senate will determine what happens.

Smith sees three possible scenarios. First, there’s the status quo. If control of the House, Senate, and presidency stays the same, it’s likely there will be just a one-year delay. Second, a longer delay is likely if Republicans take control of both the Senate and the House. Third, if the Republicans take control of everything (presidency, House and Senate), current health legislation would, Smith believes, be “thrown into nebulous territory. I-10 could be lost in the mess of the Affordable Care Act.”

In truth, says Smith, the bottom line is clear: “It’s still uncertain.”

Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.