President Barack Obama signed the Protecting Access to Medicare Act of 2014 into law Tuesday, which, in addition to shielding physicians from a 24 percent reimbursement cut under Medicare's sustainable growth formula and delaying the implementation of the two-midnight rule, also delays the nation's switch to ICD-10 coding by at least a year.
Now, HHS cannot require healthcare providers to switch to ICD-10 until at least Oct. 1, 2015, according to the text of the new law.
This most recent delay (the transition was also delayed in 2012) deals a financial blow to hospitals and health systems that have devoted significant resources to ensure readiness for the Oct. 1, 2014, transition, which CMS Administrator Marilyn Tavenner had assured providers just two months ago would not be delayed further.
"Although I know that many small practices were not ready for ICD-10, the majority of hospitals and payers were ready for 2014," wrote John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston, in a blog post. "A delay in 2013 may have been helpful, but a delay in 2014 is just going to cost hospitals more as timelines and consulting engagements are extended."
Pamela Arora, senior vice president and CIO of Children's Medical Center Dallas, was able to quantify the financial impact of the delay to her organization. "At Children's, with 45 downstream systems beyond the electronic medical record changes required, the two years' delay will cost over $1 million. With this money, for example, we could purchase roughly 170 physiological monitoring devices and place more tools in the hands of our clinicians. Many of these types of purchases are delayed when the funds are constrained.
"As a not-for-profit organization that provides $55 million in charity care and has a 65 percent Medicaid base annually, this directly affects the capacity of care we can provide in the community," she says.
For Joey Hobbs, CIO of Community Hospital Anderson (Ind.), which has already successfully tested ICD-10 claims, the delay means the expense of maintaining the testing procedures for another year while undergoing system upgrades or making any other changes that may be necessary in the next year.
Additionally, the delay could affect Community Hospital Anderson's staffing levels. "We have coders that had planned to retire after Oct. 1. Now we will all need to sit down to see what they want to do," says Mr. Hobbs.
Now, all eyes are on CMS for more information about the new transition deadline. "CMS must now provide new guidance to the industry on what the delay means for providers, vendors, clearinghouses and other concerned parties," says Russ Branzell, CEO of the College of Healthcare Information Management Executives. "The delay leaves numerous unanswered questions from testing, training and revamping the agency's education resources, such as the CMS eHealth University, designed to help providers understand, implement and successfully participate in the conversion process."
As CIOs struggle with how to adjust ICD-10 plans, CHIME will work to get providers necessary information as well as the assurance the transition will happen Oct. 1, 2015. "We will look for information from CMS as it becomes available and will continue to work diligently with stakeholders to prevent any further delay beyond 2015," says Mr. Branzell.
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