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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:

  • Administrative functions, such as billing and claims processing;
  • Health management functions, such as medication management, most clinical decision support, patient matching and electronic access to clinical results; and
  • Medical device functions, such as software for bedside monitor alarms and radiation treatment.

Administrative functions pose little or no risks to patient safety, the agencies argue, and will require no additional oversight. Health management functions will largely be the purview of ONC, who will regulate based on certification and conformance testing. And medical devices functions, which are already the purview of FDA regulations, will remain so. The report also calls for ONC to create a public-private Health IT Safety Center in collaboration with other agencies and stakeholders, which would work on best practices and provide a forum for information exchange. The agencies intend to solicit comments and announce a public meeting on the draft report within 90 days, before finalizing the strategy and recommendations. CHIME will soon announce a workgroup to respond to the draft report, please contact Angela Morris for more information.

26 Federal Agencies Define Telehealth in 7 Different Ways

Why it Matters: In a study published by Telemedicine and e-Health, 26 Federal Agencies define telehealth in seven different ways with “nuanced differences that reflect each organization’s legislative intent and the population they serve.”

Key Takeaway: At a time when remote monitoring and teleconferencing technologies are becoming more sophisticated and widespread in healthcare, and more states are granting providers licensure for telehealth billing purposes, a common Federal definition for telehealth has emerged for use by the government, developers and consumers.

This study comes at an opportune time as last year a group of Representatives introduced the Telehealth Modernization Act (H.R. 3750) and this year’s bicameral, bipartisan SGR repeal bill (H.R. 4015/S. 2000) asked for a study on the definitions for telehealth across different agencies and they both sought to create one Federal definition for telehealth. This study seems to cover just that – it identified the different definitions of telehealth across Federal agencies, and studied the similarities between them. With the definitions broken down by similarities, government agencies and/or Congress can work together to create one Federal definition for telehealth. Offices involved in the study represented the following agencies: HHS; Departments of Defense, Justice, Labor, Transportation, Veterans Affairs, Agriculture, and Commerce; as well as the FCC, NASA and NSF.

Register Now for Second Annual CHIME Public Policy Event in Washington, DC

Make plans to attend the CHIME Second Annual Public Policy Forum being held from 12 to 2 p.m. on Wednesday, April 30, in Washington. CHIME President and CEO Russ Branzell, along with five CHIME members active in the public policy arena, will be presenting on the topic of Connected and Converging Health: Patient generated health data, telehealth, and taking care to the patient; and the next phase of healthcare transformation.

You may RSVP here or contact Angela Morris for more information.


The Health IT Summits gather 250+ healthcare leaders in cities across the U.S. to present important new insights, collaborate on ideas, and to have a little fun - Find a Summit Near You!


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