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Washington Debrief: ICD-10 Delayed—What’s Next?

April 7, 2014
by Jeff Smith, Senior Director of Federal Affairs
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Jeff Smith, Senior Director of Federal Affairs

Key Takeaway: President Obama signed the “Protecting Access to Medicare Act of 2014” last week, which avoided statutory cuts to physician reimbursements and delayed implementation of ICD-10.

Why it Matters: Health IT leaders will likely need to develop a strategy to mitigate lost ROI for their efforts to date. Whatever the deadline for ICD-10 may be, CIOs should be mindful of how to make a flexible, yet dedicated, plan to transition.

What’s Next: CHIME will work with the Centers for Medicare & Medicaid Services (CMS) to issue guidance for the industry and work with partnering organizations to help mitigate lost investments.

An idea whose time had seemed to come will have to wait at least another year. A multi-year conversation over how to change physician reimbursement had finally come to an end, with politicians in both chambers, across both isles, agreeing on a policy path away from Fee-For-Service (FFS). But then, Washington happened. A plan to permanently fix the sustainable growth rate (SGR) by transitioning Medicare reimbursement from FFS to a system based on value and outcomes had been agreed to by all the right players, including physicians. But, policymakers had not agreed on a way to pay for it all, which ultimately unraveled the entire effort. A must-pass bill resulted to avoid a massive cut in physician pay and this attracted a wide array of extension and delay provisions. For IT executives, the delay that rippled throughout the industry was that of ICD-10 from October 1, 2014 to no sooner than October 1, 2015. The legislative wording and the process by which it came to be the law of the land is a subject of wide conjecture: Which lobbyists were responsible? Why was there a voice vote in the House? Does Congress even know what they’ve done? These and related questions are of little consequence now, instead executives need to ask, what should I do next?

While CHIME members are in various stages of transition, every IT executive should be thinking about how they would recommend moving forward and how they can leverage any and all investments made to date. For some, this might entail periodic training of coding staff or it might entail further changes to their clinical documentation improvement efforts, and for others, it might mean some additional breathing room to organize more education and training. For its part, CHIME staff in Washington will look for ways to help ensure that whatever path CMS chooses to take, it is informed by members’ experience and expertise.

Administration Issues Draft Regulatory Framework for Health IT

Key Takeaway: Three federal agencies released a draft report proposing a risk-based regulatory framework for health information technology, as required by the Food and Drug Administration Safety and Innovation Act (FDASIA).

Why it Matters: The report represents the final piece to a puzzle being constructed in Washington by policymakers to determine the best way to ensure patient safety without limiting innovation for healthcare software. This policy debate will likely continue into the next Congress, as legislation looks to build upon the administration’s risk-based framework.

Developed in conjunction with the Office of the National Coordinator for Health IT (ONC), the Food & Drug Administration (FDA) and the Federal Communications Commission (FCC), the draft report proposes three separate risk categories for health IT functions: