To ICD-10 Delay or Not To ICD-10 Delay

UPDATE: It looks like this bill has passed the house with a voice vote. I believe it still needs to be passed by Congress and not be vetoed by the President.

UPDATE 2: Late on 3/31/14, the Senate passed the bill which delays ICD-10 by a vote of 64 – 35. Barring a veto from the President, the bill will go forth and the ICD-10 implementation date will be moved to October 1, 2015. All of the discussion for the bill was around the SGR fix with no conversation around the ICD-10 delay. It’s unlikely that the President would even consider a veto of this bill.

We’d already stoked the ICD-10 delay fires in Kyle Samani’s post on “Why ICD-10?” before the news came out yesterday that a one year ICD-10 delay was put in an SGR bill. Word on the street was that the bill would be put up for a vote today. However, I hear now that the vote on the bill is going to be delayed at least until tomorrow.

The reports are saying that this bill was developed by John Boehner and Harry Reid which likely means they have enough votes to make it a reality. I read that Nancy Pelosi said on CSPAN that the bill wasn’t perfect, but needed to be passed. My only question is whether the delay in voting is because they’re still trying to cull votes for the bill or something else.

As I suggested in my post linked above, my guess is that congress is hearing from both those for delaying ICD-10 and those who oppose delaying ICD-10. I bet they consider the response a wash and so it won’t sway them either way. Plus, I bet that most in Congress are only talking about the SGR portion of the bill without much discussion on the ICD-10 delay.

This decision is going to cut many people. Let me share a few of the comments I’ve read.

First, from the LinkedIn AHIMA group, here’s a coder perspective on the delay:

I think of the coder who is a single mom struggling from pay check to pay check who had to spent $500 (or more) to take a course and another $60 on the proficiency exam, spent time away from caring for her family to prepare for the implementation only to have the rug pulled right from under her. The $560 is likely her discretionary income for the month. Who is thinking or her?

Don’t tell us there will absolutely be NO delays, allow us to spend our hard earned money to prepare, and then say “just kidding– we are going to tease you with another year — make you spend more money — promise no delays — then change our mind again!” “Oh, and the check is in the mail.” Yes ladies and gentleman, this is our government working “for the people.” And I ask, why does Congress even care about ICD-10? Do they even have a clue what they are voting for or against? They are trying to quietly slip it into a bill so that no one notices. I could be wrong, but it sounds like the work of a single lobbyist and Senator/Congressman. I would like to know the name of the person who put that language into the bill. Democracy at its finest!

Now a perspective that is likely shared by the thousands of ill-prepared practices and hospitals (although, my guess is that it was their larger organizations that lobbied for it, not the individual practices and hospitals that aren’t prepared):

As bad an idea as it is, a majority of practices, and a significant number of hospitals, health systems and other providers are, or feel, very un-prepared for the transition, and so have lobbied for delay. D.C. insiders say it’s a done deal.

On the other side is the prepared health IT vendors that think that a delay is letting the ill prepared off the hook. One EHR vendor sent me an email with this message:

This really is a pain to a vendor like us that is all ready to launch and take good care of our clients with ICD-10. Everything we programmed came out great and we are ready to go.

This feeling doesn’t just apply to health IT vendors that have procrastinated, but to all the procrastinators:

Why prolong the inevitable, again? The procrastinators should be penalized, not the rest of us who’ve been preparing for it.

What we all want most is certainty. HHS came out with certainty during HIMSS when they said that there would be no more delays with ICD-10. Unfortunately, HHS doesn’t control congress.

I’ve been reading a lot of reports that a delay in ICD-10 would cost billions of dollars. I’m not sure I trust those numbers, but it’s no surprise that those numbers don’t take into account the impact and cost of ICD-10 being implemented. Personally, I see costs in ICD-10 going forward and costs in ICD-10 being delayed. I’m not sure we can quantify either number accurately.

Obviously, this is a fast moving story, so I’ll update this post with any updates as I get them. Feel free to leave comments with updates as well.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

10 Comments

  • As with all things Washington, business wants Stability of Policy that has been severely lacking. This has been the major reason for the lack of growth overall.

  • John,
    thanks for sharing the comments you’ve received. Can you also share them with your Nevada senators? They need to hear from all involved. The financial impacts of the delay are far reaching.

  • I really feel sad for all those folks who don’t get to implement a coding system with no clinical benefit that will waste billions of dollars that could be spent in far better ways than learning how a macaw attack should be coded.
    The delay cause anyone to lose jobs or have their office close because all their claims are rejected. I fail to hear while scattered folks in the emr world seem to think they are ready that the healthcare payment system as a whole is system ready to receive and process claims. If they were I suspect I would be advised to have six months of capital available to pay my staff because the system will not be able to pay me.
    Hopefully this is the first step in a process to kill ICD 10 altogether and for my part….Thank you Jesus

  • I love Kerry’s comments above.

    First and foremost, yes we vendors had to spend money once again on ICD 10. Most of us did this a while back,on the first cry wolf. But this is not the first it is like the 5th it’s happening.

    What is the real benefit of this, how does it really help anyone but the big vendors, that will market ICD 10 and MU Stage 2 2014 Certification to steal the still large amount of end users that use small EHR solutions.

    I see absolutely no benifit in fixing the ICD codes to classify diseases down to the granular level. I am well aware of the coding differences.

    I actually thought SNOME-CT Clinical Terminology should have been mandated for EHR certification of Problem Lists, it is much better then even ICD 10 and is in use in a lot of other countries because of that. Treatment of patients and coding is not the same as billing for services, at least not now,and not with ICD10 either.

    Why make the world change, the government change on there end, etc…. for no gain. This whole ICD10 conversation is as repetitive that at this point if they ever implement it it will be another disaster move by HHS.

  • Even if the AHIMA sob story about the lady who paid $560 for an ICD-10 course and $60 for certification/proficiency was true … it should be reimbursed by her employer or employer to be. In any case … it is tax deductible expense.

  • Actually I reread my post one mistake.

    “Why make the world change”

    In irony, that is the one major argument for our country to go to ICD10, all the rest of the world is on it, and when sharing or receiving patients from other countries (i.e. Canada) it is a pain to get ICD10 and crosswalk it back to ICD9.

    The only true great argument is ICD10 been around a long time and we are the last to change. But we are the last in a lot of things in this regard.

  • Don B,
    That’s pretty cynical. Whether the specific story is true, I know that 1000s of coders are in a similar position. Many had to pay it out of their own pocket instead of their company’s and tax deduction offers a 5-10% discount. When you realize what a coder gets paid, that’s a big deal for them.

    The point is that many individuals are going to be impacted by this delay. On a macro level, there are a lot of arguments that go both ways.

  • It is NECESSARY to implement ICD10 sooner than later. The U.S. is already 10 plus years behind every other industrialized nation. In order to keep up with tracking, identifying and analyzing new clinical services and treatments to patients, we must have updated codes. ICD9 is outdated and imprecise. Additionally, without ICD10, the return on investment to an organizations EMR and health data exchange is greatly diminished. #NoDelay

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