ICD-10 delay increases transition costs and confusion

The proposal to delay the mandatory implementation of ICD-10 coding went from introduction to being passed by Congress in less than a week and left many hospital and health system CIOs, CMIOs and consultants across the country scrambling to figure out what their next steps should be.

One of the most pressing issues was staff and physician training, which had either started or was about to begin. Would training now, a year ahead of time, mean that much of what was scheduled to be taught would be forgotten by the time the new implementation deadline rolled around? And without the urgency of a looming deadline, would busy physicians make the time to attend the trainings?

According to a statement issued by the American Health Information Management Association (AHIMA), previous implementation delays had already increased costs and this one-year delay might add an addition $1 billion to $6.6 billion in direct implementation costs for the U.S. healthcare system. That is not including the indirect lost opportunity costs that would come from delaying the move to ICD-10, which AHIMA says is essential to fully realize the benefits of the investments in electronic health records and maximizing the cost savings and patient safety benefits that could come from well functioning health information exchanges.

There is also the issue of when exactly the new implementation deadline will be. H.R. 4302, the bill that delays the ICD-10 implementation, is primarily a temporary fix to the sustainable growth rate (SGR) formula’s steep cut to Medicare physician reimbursement. The ICD-10 delay is one sentence in the bill and only says that the Secretary of the U.S. Department of Health and Human Services (HHS) may not implement ICD-10 prior to October 1, 2015. It does not say that October 1 next year is the new implementation deadline.

The Centers for Medicare and Medicaid Services (CMS) is the HHS agency that will need to provide clarification on when exactly the new deadline will be and what providers should do next, particularly as it concerns training. However, CMS may have been as surprised as providers were by the delay. Just five weeks ago at the Health Information and Management Systems Society (HIMSS) Annual Conference, CMS Administrator Marilyn Tavenner stated unequivocally that, "there will be no change in the deadline for ICD-10.”

AHIMA has more than 72,000 members and noted on their blog that thousands of them called their elected officials to push for the delay being dropped from the SGR fix bill. However, with House and Senate leadership committed to getting a fix done in a week to avoid the SGR kicking in on April 1, there was little that could be done to stop the bill.

A related issue, AHIMA says, is what will now happen to the 25,000 students currently in health information management (HIM) associate and baccalaureate educational programs that have switched to teaching only ICD-10 codes. They will graduate unable to code in ICD-9 and will have to wait a year for their coding skills to be applicable.

“As demands for quality healthcare data continue to increase, this delay will add an additional significant hurdle for the healthcare system to fill these important HIM positions,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, on the AHIMA blog.