This month, President Obama signed a piece of legislation that delayed a menu of healthcare policies. The law put off Medicare's sustainable growth rate cuts to physicians, and it also gave hospitals extra time for the two-midnight rule.
But the most interesting delay stems from one minuscule sentence on page eight of that law: "The Secretary of Health and Human Services may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for code sets."
That's right. For the second time in two years, ICD-10 has been pushed back. What makes this delay most significant is the fact CMS reiterated time and time again that another delay will not happen, which in turn led many providers to move ahead, full force, to adopting it.
To be fair, CMS had no role in this delay, and it caught many people off-guard. There's unfortunately no hard link that could be made as to how the delay found its way into the legislation. This was likely the work of some healthcare lobbying group(s) that somehow got a member of Congress to include that tiny phrase in hopes that most would overlook it, in favor of getting the "big" deal done: That is, staving off the SGR cuts. An apparent backroom deal at its finest.
Now, at the earliest, ICD-10 will be the primary coding system in the U.S. by 2015. This most recent delay is a rather stark example of how dysfunctional the healthcare system still is and will be.
Before I go on, I will acknowledge that ICD-10 is yet another costly initiative for hospitals and physicians amidst healthcare reform. And a change of this magnitude, going from the 13,000 diagnosis codes of ICD-9 to the 68,000 diagnosis codes of ICD-10, is rife with challenges. It should also be noted that I am far from a coding expert.
But here is the bottom line: ICD-9 is roughly 40 years old, and ICD-10 is more than 20 years old. That means if ICD-10 somehow goes live in the U.S. next year, it will already be out-of-date by more than two decades. And the World Health Organization is getting ready to roll out ICD-11 in 2017.
Last year, I interviewed Jon Handler, MD, a board-certified emergency physician and the former director of emergency medicine research and informatics at Chicago's Northwestern University Feinberg School of Medicine. He made a compelling case for the U.S. healthcare system to abandon ICD-10 — and this was well before the most recent round of political football.
He's not alone in this view either. In 2012, five leading medical informatics experts — including John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston — wrote an article in Health Affairs arguing that ICD-11 and SNOMED, not ICD-10, should become the focus of healthcare leaders today.
For CIO, CFOs, physicians, coders and others that have heavily invested in ICD-10, both financially and clinically, this delay is the type of news that could force them to rip out their hair. Perhaps worst of all, providers now have to ask themselves: Should I continue to push ahead with ICD-10? Is it even worth my time anymore? How do I know it won't be punted again next year?
ICD-10 was so close to coming to fruition, with many innovative and fun efforts sprouting up along the way, but the latest saga goes to show: Progressive change in the United States remains elusive, and change only comes when the most powerful are ready for it.