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D.C. Report: ICD-10 Compliance Delay an ‘Appropriate Middle Ground’

May 15, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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CHIME Calls Proposed One-Year Delay to ICD-10 an ‘Appropriate Middle Ground’ The College of Healthcare Information Management Executives (CHIME) today submitted comments to Health and Human Services Secretary Kathleen Sebelius regarding a notice of proposed rulemaking to postpone the compliance date for International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10) to October 1, 2014.

In its comments, CHIME urged HHS to remain committed to ICD-10, while calling the one year delay an appropriate “middle ground” for all stakeholders. 

“A longer delay would seriously disrupt ongoing efforts to convert to ICD-10,” the letter said. “And, as HHS itself recognizes, a longer delay would significantly increase the costs of converting to ICD-10. Thus, we compliment HHS for attempting to balance the interests of all stakeholders by identifying a middle ground between those who urge a longer delay, which we believe would create more problems than it would solve, and those who would prefer no change in the compliance date.”

The April notice of proposed rulemaking followed an earlier announcement by the Secretary that a delay was imminent. In response to that announcement, CHIME wrote to HHS Secretary Sebelius in February, urging HHS “to move quickly and decisively in setting a new compliance date for converting to ICD-10.” In its letter, CHIME said a prolonged delay to ICD-10 implementation, or more specifically, prolonged uncertainty about the timing and details of a delay would create more problems than it would solve.

Congress Circles Wagons on SGR The Sustainable Growth Rate (SGR) formula was front and center in Washington this week, as both the House of Representatives and Senate made headlines on the matter.  A bipartisan bill meant to repeal the SGR formula and address reforms in Medicare payment and delivery was released this week by Representatives Allyson Schwartz (D-Penn.) and Joe Heck (R-Nev.).  The bill provides immediate relief from cuts of over 30 percent to physician payments scheduled for January 1, 2013, and puts in place delivery system and payment reforms to “ensure long-term stability in the Medicare physician payment system, and contains the rising growth in healthcare costs,” a press release from Rep. Schwartz said.

The Medicare Physician Payment Innovation Act is the first bipartisan bill to emerge in this Congress that would replace the SGR and it would be paid for by using unspent Overseas Contingency Operations funds (funds made available through the drawdown of operations in Iraq and Afghanistan).  The use of OCO funds has been publicly rejected by Republican leadership, but some rank-and-file Republicans have said privately that they would support use of OCO funds, but only to help eliminate the huge SGR debt.

The Schwartz-Heck bill would also establish a six-year transition period, during which time physicians would get modest increases and CMS would be have to establish at least four alternative payment models from which physicians can choose.

Additionally, the House Ways and Means Committee Republicans sent a letter to just under 70 medical societies, asking for advice on how to incorporate quality measures into a new Medicare physician payment formula.  Further, committee Republicans are asking the groups to describe alternatives to fee-for-service models, such as bundling arrangements and shared savings programs that commercial payers have worked out with physicians and if there are regulations that block needed changes to how physicians deliver health care.

On the Senate side, Senate Finance Committee Chairman Max Baucus (D-Mont.) held a “roundtable” with three former CMS administrators to discuss short-term and long-term options for the SGR.  Bruce Vladeck, Thomas Scully and Mark McClellan were asked by the committee to submit their plans within a month, though two of the three cautioned against going further toward hospital-based payment systems — which are stressed in the ACO model – or trying to dramatically reshape the incentives and structure of the health system through the way doctors are paid.

Report Finds Major Funding Loss to Health Research amid House Plans to Slash Funding To Poor According to a report released this week, if Congress doesn’t pass alternative legislation later this year to block automatic cuts required under the budget control law, funding for health research is going to take it on the chin.  Research America, an organization that lobbies for medical research funding, published the report, “Sequestration: Health Research at the Breaking Point,” finding that the National Institutes of Health (NIH) would lose $2.39 billion, the Centers for Disease Control and Prevention (CDC) $445 million, the Food and Drug Administration (FDA) $191 million, and the Agency for Healthcare Research and Quality (AHRQ) $29 million from their fiscal 2013 budgets.  CDC Director Thomas Frieden said this in response: “An eight percent to ten percent reduction, on top of 50,000 front-line public health professionals already lost at the state and local levels, will risk costly and deadly spread of disease and failures to prevent tragic and expensive health problems.”