The Truth About the ICD-10 Delay

On April 1, 2014, President Obama signed into law HR 4302—a bill that, among other things, delays ICD-10 implementation for an entire year (to October 1, 2015). Despite the date, this was no April Fool’s joke—although I wish it was. In my opinion, this was a bad move on the part of our government. Why? For one reason, ICD-9 is more than 35 years old, which, considering the pace that modern medicine advances, makes it more than outdated; it’s practically archaic. For another, this is now the third time the implementation of ICD-10 has been delayed. It’s been years of “hurry up and wait.” It’s enough already.

In this press release, Jon Lindekugel, president of 3M Health Information Systems, sums up his opinion of the most recent delay quite well: “The vote to delay ICD-10 is a vote for the past, not the future of health care. If we are to improve patient outcomes and safety, enable modern-day research, promote innovations in healthcare delivery, and achieve cost-saving efficiencies, the healthcare industry must have access to higher quality information afforded by ICD-10 coded data.” It’s that simple.

Richard Averill, 3M Health Information Systems’ senior vice president and research director, agrees: “Never in US history have we used the same version of the ICD codes for 35 years. The Congressional vote to delay ICD-10 puts US health care years behind the rest of the world, which has been using ICD-10 coded data for more than a decade. Without ICD-10 data, there will be serious gaps in our national healthcare community’s ability to extract important patient health information needed to advance initiatives…”

Who knows what exactly pushed Congress to agree to yet another delay. In this journal article, the American Health Information Management Association (AHIMA) says it was “likely done to placate physicians who are against an SGR patch”—another point of HR 4302 contention. While I wish they had fixed SGR rather than simply patched it, I understand time had run out, and I’d rather have a patch than nothing at all. That being said, it was a sly move to insert an ICD-10 delay into a bill that had nothing to do with the diagnosis codes. The ulterior motive becomes more apparent as the article progresses, stating that the American Medical Association (AMA) is “against moving to ICD-10 entirely.”

In this letter to the US Department of Health and Human Services, James Madara, MD, executive vice president and CEO of the AMA, explains why his organization is not in favor of the transition: primarily because they do not believe that it will “improve the care physicians provide their patients.” Madara also goes on to say that the cost associated with the transition as well as its close proximity to the implementation of EHR Meaningful Use Program standards are prohibitive. What he fails to mention, however, is that the government has been incentivizing physician practices ($44,000 through Medicare program or $63,750 through Medicaid one) to adopt electronic health records, technology which also should help prepare them for the ICD-10 transition. Yet, a recent survey from the Medical Group Management Association (MGMA) found less than 10% of physician practices were ready for ICD-10. That’s pretty low— staggeringly low, really—especially when you consider the fact that ICD-10 has been the “national coding standard” since 2009. So, contrary to what the AMA’s letter appears to hint at, there really weren’t any surprises here. Their excuses sound a lot like “the dog ate my homework”—nothing more than procrastination.

And what about the rest of the medical community that no one bothered to survey (or incentivize)? I know for a fact that there are plenty of physical therapy clinics that have already invested their own time and resources into upgrading their systems, contracting vendors, hiring consultants, and conducting training to ensure their preparedness. Additionally, AHIMA points out that “the delay directly impacts at least 25,000 students who have learned to code exclusively in ICD-10 in health information management (HIM) associate and baccalaureate educational programs.” Should the individuals who were ready be punished because others were not? Plus, the medical community as a whole has already spent millions of dollars in educational grants from the HITECH Act to prepare employees for the ICD-10 transition. According to AHIMA, CMS estimates that this one-year delay will “likely cost the industry an additional $1 billion to $6.6 billion on top of the costs already incurred from the previous one-year delay.” And this doesn’t even take into consideration “the lost opportunity costs of failing to move to a more effective code set.” Where is the accountability in our system? Don’t the powers that be see the irony of approving a delay that’s going to cost us billions of dollars in the same year they implement something called the “Affordable Care Act”?

For everyone who was thoroughly prepared, for everyone who believed CMS’s promise that there would absolutely not be another delay, for everyone who knows that the transition to ICD-10 is beneficial to us and our patients—this is unfortunate. It’s essentially a punishment for doing the right thing. We were supposed to be spending 2015 enjoying the fruits of our labors, not toiling for yet another year in transitional hell. But the past is the past, and what’s done is done. So let’s talk about how we’re going to handle the future. Let’s please, please get our acts together this time. All of us. Let’s make sure we’re ready. Let’s make sure that there isn’t another delay. Let’s actually start using ICD-10 on October 1, 2015, because I, for one, really don’t want to see the US fall behind the rest of the modern world any more than it already has. Do you?

What do you think about the delay? Tell me your opinion in the comments section below.