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A Disappointing Delay

April 2, 2014
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“They all disappoint. Closer you get, the more you look. All of them."

The quote above is from one of the greatest TV shows of all time: The Wire. It focused on how various institutions of the American city are very much on the decline, be it schools, blue-collar institutions, or the newspaper.

In this case, that quote was referring to politics and politicians. In the show, Baltimore Mayor Tommy Carcetti leaves money on the table that could have greatly helped the city’s woeful education debt. He does it out of pride and political ambition. His campaign manager/advisor is infuriated and later, having a drink with another campaign manager, expresses his disbelief that Carcetti would do such a thing. The other manager responds with those jaded, cynical words.

Why am I bringing this up? It’s simple. I’m disappointed. The third delay of the transition to the 10th classification of the International Classification of Diseases (ICD-10), embedded in the equally disappointing Sustainable Growth Rate (SGR) payment patch, is as disillusioning as it gets. It’s shady backroom politics. It’s House of Cards. It's what makes people distrust the political system.

A month ago, at the annual Healthcare Information and Management Systems Society (HIMSS) conference, Marilyn Tavenner, R.N., administrator for the Centers for Medicare and Medicaid Services (CMS) got on stage and affirmatively told everyone that there would no more delays to ICD-10. None. Zip. Ninguno.

 "By now, folks understand that there will be no more delays. Let's face it guys, we've delayed it more than once and it's time to move on," she said at the time.

You hear that? No. More. Delays.

Exactly one month later, the U.S. House of Representatives passed the one-year delay of the temporary Sustainable Growth Rate (SGR) "doc fix" bill with a voice vote, which included at minimum, a one-year delay of the ICD-10 transition. The U.S. Senate passed the legislation itself on Monday and President Obama signed it into law on Tuesday.

ICD-10? See you next year! Just like that.

Ms. Tavenner, I think you have an egg-like substance on your face. Shall I clean it off for you?

We used to see this happen in school. It's when a student (the anti ICD-10 lobbyists) who is falling behind on a project goes to Mommy and Daddy (the politicians who enacted this bill), who just happen to be on the school board, and get an extension put in place. All the while, the overruled teacher (Tavenner, unfortunately, for her) sits there as the unwitting victim, looking silly for having simply re-affirmed the due date.

The SGR is a debacle in itself. Unfortunately, as many have pointed out to me, it was essentially unsolvable in an election year. No one was going to be the “Cuts to Medicare” party in November.

But why ICD-10? We know it’s not the most popular mandate, but even many of the groups that have actively advocated against it weren’t on board with the payment patch. The American Medical Association (AMA), Medical Group Management Association (MGMA), and a host of others were upset by the passing of H.R. 4302, also known as the Protecting Access to Medicare Act of 2014.

The one group I noticed that was publicly happy about this, the Reston, Va.-based American College of Radiology (ACR), had other reasons for their delight. The law contains a number of evidence-based imaging provisions that the group had lobbied for inclusion.

Someone wanted ICD-10 in that bill. For some reason, that group/person is not coming forward.  As has been suggested to me by an industry source, it’s possible that it’s someone who is lobbying against the bill, but knew it was going to pass anyway and got it in there. Or, it could have been included as a sweetener to get the AMA on board. Or it could have been the work of specialty medical societies, as has been implied by Sharon Canner of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME).

Regardless of why, it doesn’t really matter. What’s done is done. ICD-10 is delayed at least one more year. For many, this will be costly. The American Health Information Management Association (AHIMA) says that another delay could cost up to $6.6 billion on top of costs incurred from the previous delay. Other providers have hinted at the same reality.  

But it’s not just money being lost, it’s credibility.  

I interviewed a bunch of CIOs and IT leaders in 2013 for a Healthcare Informatics feature. Back then, everyone seemed certain there would be no more delays. Randy McCleese at St. Claire Regional told me his organization was preparing for the transition as if the date was cut in stone. John Halamka, M.D. CIO at Beth Israel Deaconess, also seemed certain the deadline was definite.

What a difference less than a year makes. In his blog this week, Dr. Halamka suggested that perhaps ICD-10 should be skipped altogether and the government should move towards transitioning to ICD-11 in 2018. I bet he isn’t the only one who has had that thought.

Just like the teacher who has been overruled and keeps pushing back the project’s due date, people will eventually stop believing something is actually coming when delays and extensions keep happening. In the case of ICD-10, we may have reached that point.

Please feel free to respond in the comment section below or on Twitter by following me at @HCI_GPerna

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