Note: This is not an April Fools’ joke.
On March 31, the US Senate voted 64-35 to approve a House-drafted bill that includes a provision to push the ICD-10 deadline back a year—all without a single mention of ICD-10during a nearly three-hour Senate floor debate. The main purpose of the bill—HR 4302—was to enact a one-year “fix” of the Sustainable Growth Rate (SGR) formula, thus preventing a 24% cut in Medicare’s physician reimbursement rate. This legislation represents the 17th temporary Medicare fix since the passage of the Balanced Budget Act was in 1997. According to an APTA press release, “the final bill replaces the cut with a .5% provider payment update through the end of the year and no update from January 1 to April 1 in 2015.” In addition to the SGR patch and the ICD-10 delay, the bill includes one-year extensions for the therapy cap exceptions process and the Geographic Pricing Cost Index (GPCI). The bill now awaits President Obama’s signature, which, according to social media buzz, should occur today.
As this article explains, no one is quite sure how an ICD-10 delay made its way into the SGR fix bill. Although the legislation was the product of a bipartisan effort, there were senators from both sides who vocally opposed its passage, citing the importance of paying for the quality—not the quantity—of healthcare services. However, in the midst of all this passionate debate, not a single Senator mentioned ICD-10—much to the chagrin of the associations that so vehemently opposed the implementation delay, including the College of Healthcare Information Management Executives (CHIME), the American Health Information Management Association (AHIMA), the Medical Group Management Association (MGMA), the American Medical Association (AMA), the Health Information and Management Systems Society (HIMSS), and the Centers for Medicare and Medicaid Services (CMS).
So, why the silence on ICD-10? One theory is that lawmakers were simply unaware of the ICD-10 provision and its potential implications. As this Government Health IT article suggests, “Perhaps if the Senate had voted down the bill, regrouped, come back with another stab at permanent SGR repeal, someone would have noticed Section 212 saying that HHS cannot mandate ICD-10 as the standard code set before Oct. 1, 2015.” But now that the delay is happening, the healthcare industry must face the financial consequences. CMS estimates that the total cost of delaying implementation will fall somewhere between $1 billion and $6.6 billion, and Resultant founder and healthcare consultant Joe Lavelle projects that waiting another year could cost each of his clients anywhere from $500,000 to $3 million, according to the Government Health IT article.
With no indication that President Obama will exercise his veto rights, this bill should become law today. We’ll update this post as the story unfolds.