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Not Everyone Down on Another ICD-10 Delay

March 27, 2014
by Gabriel Perna
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While much of the response in healthcare IT to a possible one-year delay to the ICD-10 compliance date has been negative, not everyone is down on that possibility.

Indeed, in an interview with The Washington Post, Rob Tennant, senior policy adviser for the Medical Group Management Association (MGMA) laid out some of the positives to another delay to the compliance date of the coding system. He said that “a thousand different cogs that have to work smoothly” in order for ICD-10 to run and that many of those “cogs” are not ready.

The delay is part of a bill that would also provide a temporary one-year patch to the Sustainable Growth Rate (SGR) formula. The bill passed the House on Thursday and will now be moved onto a Senate vote, which according to CSPAN, will come on Monday. If it passes both the House and Senate, it will likely be signed into law by President Barack Obama, sources say.

The SGR formula determines how physicians are reimbursed for Medicare. The formula attempts to control growth in Medicare spending on physician fees by tying reimbursement to economic growth.

On the ICD-10 front, MGMA has been one of the prominent advocacy organizations that have stood behind another delay to the compliance deadline. The group conducted a survey of its members and found that less than 10 percent of physician practices are ready for the switch to ICD-10 code-set.

Despite this, Tennant told EHR Intelligence that MGMA was aligned with the other physician groups in opposing the bill in favor of a permanent fix to the SGR.  He did, however, go onto to reiterate MGMA’s previous position that many in the industry were not ready for the ICD-10 code-set.

Another group that has been against the ICD-10 transition, the American Medical Association (AMA), would rather see a temporary repeal and replace to the SGR formula than a delay of the ICD-10 code-set. Since the bill was announced, it has been actively attempting to get its members to overturn the temporary pay patch.

Anita Samarath, CEO of Clinovations Government Solutions, a Washington D.C.-based consultancy, told Healthcare Informatics that groups like MGMA and the American Medical Group Association (AGMA) are serving constituents that would benefit from a delay. Further, she says, both these organizations and their constituents may see a financial windfall if the compliance date remained Oct. 1, 2014.

 “Maybe they are doing the analysis finding their constituents are going to be negatively impacted by the (ICD-10) mapping if they do nothing. That means their revenues would go down as well,” Samarth says.

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Comments

Can someone clarify what the last 2 sentences of this article mean?

Did the AMA & MGMA want the ICD-10 delay or not?

What does “do nothing mean?” And how is the windfall achieved?

Maybe I need more coffee but this is not clear to me at all.

Do nothing - as in..if they don't advocate that there should be a delay of ICD-10. The AMA and MGMA wanted the delay. They didn't want the SGR payment patch and because they hold a permanent repeal of the SGR in higher regard, they didn't think a delay of ICD-10 was worth it. That being said, now that it's official, I'm sure they won't complain about that aspect of the bill.

Hope this clears things up.

So ICD-10 per se has nothing to do with actually losing revenue or gaining a financial windfall - the delay was just a side effect/benefit of being tied to the SGR fix. That's what I'm reading.

The delay was definitely tied to the SGR fix, but there seems to be a financial windfall to ICD-10 for many specialty groups (http://www.healthcare-informatics.com/news-item/icd-9-icd-10-significant-data-financial-losses-transition) and smaller provider groups (http://www.healthcare-informatics.com/news-item/backed-new-research-ama-questions-icd-10-mandate) in particular. At least that's what many of these providers are claiming.

What Anita was saying is that since many of the advocacy organizations (like MGMA for example) represent these specialties and provider groups and work off percentages, they too would see a windfall from ICD-10. If the providers are seeing a windfall from ICD-10, then so too would the advocacy groups. This is why she says they would have angled for a delay.

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