Senator Calls for Indefinite Delay to ICD-10 For those devoted readers of Advocacy Corner, you’ll know that we’ve been covering the interplay between Congress and the ICD-10 October 2013 deadline long before HHS Secretary Sebelius first promised a delay in February.  Towards the end of 2011, several attempts were made to sneak ICD-10 delay language into “doc fix” legislation, but were unsuccessful.  Since that time, CMS has issued a proposed rule that would delay ICD-10 implementation deadline by one year to October 2014.  CHIME’s comments were largely supportive of the one-year proposal, if only because it struck an appropriate balance between those that have been asking for 2 and 3-year delays and those that would like to stay the course.  However, this week, Oklahoma Senator Tom Coburn, M.D. issued a white paper with one of the more overt calls to delay ICD-10…indefinitely.

In the “white paper,” ICD-10 Implementation Date: Better Never Than Later? Sen. Coburn and Jason Fodeman, M.D. dismiss many of the refuted claims about how ICD-10 will benefit the health system – redundant codes, unnecessary intricacies, high costs, wasted time, esoteric benefits, etc.  The paper calls on HHS to delay ICD-10 indefinitely, “until more meaningful changes are made to lower costs and reduce administrative costs.”  In a rebuttal printed by Inside Health Policy, senior director for coding policy and compliance at AHIMA, Sue Boman, argued that many of those “meaningful changes” are dependent on the use of ICD-10 and cannot wait.  “If we don't have good data, we're making inappropriate decisions based on that data,” Bowman said, and data is becoming more important, not less.

Sen. Franken Asks CMS to Reduce Medication Errors at Hospital Discharge through Changes to MU Minnesota Senator Al Franken sent a letter to CMS this week, urging them to use meaningful use regulations as leverage to eliminate medication errors for patients discharged from hospitals.  By highlighting methods used at Hennepin County Medical Center and Mayo Clinic, Sen. Franken believes billions of dollars could be saved and significant medical errors could be avoided.  In his letter to CMS Administrator Marilyn Tavenner, Sen. Franken asks that CMS adopt a policy that would require eligible hospitals to perform medication reconciliation for patients when they are discharged from the hospital. As proposed, the electronic health record incentive program would only require that reconciliation be performed upon admission and for most referrals and transfers - not upon discharge.  “The Meaningful Use program is a unique opportunity to incentivize quality interventions proven to help patients such as pharmacist-supported medication reconciliation upon discharge,” he wrote.  “I want to encourage your agency to think creatively about other ways to use the Meaningful Use incentive program to reduce medication errors and keep patients safe and healthy.”

FDA User Fee Set for Conference After House Passage. After passing the Senate last week in a 96-1 vote, related legislation on the FDA user fee bill passed the House this week 387-5. The legislation would authorize FDA to collect about $6.4 billion in user fees from the drug and medical device industries over the next five years to finance a portion of its oversight of medical products. It introduces major new user fee agreements with generic drug manufacturers and companies that produce cheaper versions of complex, protein-based drugs, called biosimilars. 

Of concern to the AC readership is that both bills have language requiring a report to Congress on strategy and recommendations for a “risk-based regulatory framework” on medical device regulation and health information technology software, including mobile applications.  It is likely that however the language comes out in the final draft, the FDA will have 18 months to consult with ONC and the FCC to come up with regulatory roadmap. [Some readers might recall that such a roadmap already exists in draft guidance form.  The Senate version prohibits such guidance from being finalized until the study is conducted.]

State Officials Say CMS May Launch Healthcare Innovation Awards for States At a Center for American Progress conference on May 22, Center for Medicare and Medicaid Innovation Direct Richard Gilfillan said that CMS is working on a program to help states revamp their delivery and payment systems, and this led state officials to believe that CMS might be creating a state-based healthcare innovation initiative (projects that are aimed at delivering “better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP”).  States were not allowed to apply for the Healthcare Innovation Awards, but state hospitals and other state-run facilities were able to apply for them. 

Inside Health Policy reports that state officials say innovation awards for states “would allow states to combine their myriad initiatives into a cohesive whole that would supercharge state-based reforms.”

With the Supreme Court decision on the Affordable Care Act around the corner, CMS is trying to find more opportunities to decrease costs and improve quality of care for patients.  Some states are already addressing their delivery and payment systems including: Arkansas, Oregon, Maryland, Massachusetts and Rhode Island.  State-level solutions would be much less controversial than federal-level solutions.  Allowing states to apply for innovation awards would likely bring many different systems together (medical homes, shared savings programs, etc.) to make a more cohesive structure.

Read about the Healthcare Innovation Awards here.  So far, projects totaling about $122.6 million have been awarded out of $1 billion set aside for the innovation awards. The next set of awards are expected to be announced this month.