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D.C. Report: One-Year ICD-10 Delay, First ACOs Announced

April 18, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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HHS Proposes One-Year ICD-10 Delay This week, HHS released a proposed rule delaying the compliance date of ICD-10, for both diagnosis and procedure codes, from Oct. 1, 2013 to Oct. 1, 2014.  In February, HHS announced that it would reconsider the timetable for ICD-10 implementation, and CHIME responded with a letter to HHS saying uncertainty about the timetable would create more problems than it would solve.  For the last two months, there has been much speculation about the possible delay, and since the announcement in the NPRM, responses have been mixed from different associations.  AHIMA is encouraging its members to implement ICD-10 as soon as possible, and would rather not have the delay while AMA is on record as advocating for a three-year delay.

For providers that have already invested time and money to move forward with ICD-10, this delay proves problematic.   Another conflict arises as October 1, 2014 is the first day of Stage 2 of Meaningful Use – and beginning the reporting period for Stage 2 and complying with ICD-10 on the same time may cause the very regulatory burdens that AMA believes a delay would reduced.

The rule also proposes adopting a standard for a national unique health plan identifier (HPID) and a related other entity identifier (OEID) for identifying certain entities other than health plans in standard transactions (such as electronic claims submission). The proposed rule would also require certain providers to require prescribers lacking a national provider identifier (NPI) to obtain one and disclose it to entities that must include the prescriber’s NPI on certain transactions.

The proposed rule will be published in the April 17, 2012 issue of the Federal Register.  A 30-day public comment period will end on May 17, 2012.  Something to consider: HHS still has the ability to take the IDC-10 delay out of final rule.

CHIME will be issuing a response to the NPRM.  If you have questions or comments, please contact Sharon Canner or Jeff Smith

CMS Announces First ACOs – 27 in All The Affordable Care Act created the Shared Savings Program in which physicians, hospitals and other health care providers create Accountable Care Organizations tasked with improving care while lowering costs.  If successful, ACOs get to share the cost savings, which could come from avoiding duplication of services and reducing medical errors through care coordination.  27 ACOs across eighteen states were approved this week, and more than 150 applications have been submitted for the program beginning July 1.

Of this initial group of 27 ACOs, five are participating in a special Advance Payment ACO Model which offers advanced payments to rural and physician-based ACOs under the Shared Savings Program to build the infrastructure necessary to coordinate care for their patients.  ACOs will repay their balances through their shared savings, and risk being liable for full repayment if they do not complete their agreement.  Over 50 of the applications being submitted to begin on July 1 are applying for the Advance Payment ACO Model.

The organizations selected during this first round have the potential to affect over 375,000 beneficiaries, HHS officials say.  Here’s the full list of ACOs.

Institute of Medicine Calls for More Public Health Spending The Institute of Medicine released a report this week asking Congress to increase spending on public health.  The report claims that “funding for governmental public health is inadequate, unstable and unsustainable.”  Despite the fact that the US spends more on healthcare than other nations, it still lags in life expectancy rates as a result in the lack of money dedicated to public health.  IOM acknowledges the growing costs of healthcare and note that public health funding has been cut by $5 billion in Congress’ attempt to save money in the short term.  These short terms savings will prove to be shortsighted, the report says, because preventative care could, in fact, decrease overall medical costs in the long run.

The Hill reports about funding allocation to offset the initial higher costs and some of the potential long-term cost-savings from preventative care.  “It suggests creating a new transaction tax on medical care services to help pay for the increased spending, which over time could lower healthcare costs by reducing obesity and tobacco use.”

The report requests funding for public health research to establish a minimum package of public health services for every community.  After these services are established, IOM estimates that Congress would need to double the current amount of public health spending (from $11.6 billion to $24 billion) to help deliver these services.  IOM also notes that once this minimum is established, a long-term plan must be created to ensure financing for these public health services.