The US House of Representatives has passed a bill that would delay the implementation of ICD-10-CM/PCS for one year. A similar bill in the Senate is expected to be voted on soon. AHIMA has called on proponents of ICD-10 to contact their senators and ask that they not delay ICD-10.

The bill, H.R. 4302 – Protecting Access to Medicare, mainly adjusts the Sustainable Growth Rate (SGR) for Medicare payments, which dictates how much physicians get paid for services. But bill section 212, a seven line section inserted into the SGR patch bill, also states that the Department of Health and Human Services (HHS) cannot implement the ICD-10 code set until October 1, 2015, a year later than the current date of October 1, 2014.

The bill introduced by Representative Joe Pitts (R-PA) states: “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.”

179281249House Speaker John Boehner (R-OH) and Senate Leader Harry Reid (D-NV) announced they were working in cooperation on the SGR “patch” bill late Tuesday night. The bill passes a temporary one year patch to prevent a 24 percent reduction in physician Medicare payments that would go into effect March 31. The development of the bill, and insertion of the ICD-10 delay, was negotiated at the leadership level in the House and Senate.

The bill was voted on and passed without a roll call vote, and was conducted immediately after an unexpected recess when many House representatives had not returned to the floor. The recess was taken for supporters of the bill to drum up more support. The afternoon vote took place following an objection to the vote in the absence of a quorum by Pitts Thursday morning. A quorum was not present for the afternoon vote.

Senate Set to Vote on SGR/ICD-10 Delay Bill Soon

Action on the SGR patch bill now moves to the Senate. Senators are expected to vote on a SGR patch bill in the coming days that could delay ICD-10, but a vote date has not yet been set. A similar bill, S. 2157, was introduced into the Senate which would also delay ICD-10 for one year. However, the Senate could vote on the House version of the bill, or vote on a different bill featuring larger reform of SGR; one ICD-10 proponents hope would not include an ICD-10 delay.

AHIMA and other proponents of ICD-10 have been rallying members and stakeholders to contact their senators and tell them to not delay the new code set. On Wednesday thousands of AHIMA members contacted their representatives and called for no further delays of ICD-10.

Further requests to contact senators and ask that they “pass a clean bill to fix SGR and not delay ICD-10″ have been made by AHIMA and the Coalition for ICD-10, an advocacy group of healthcare associations, vendors, and insurers that support the implementation of ICD-10. In a statement, AHIMA officials said that “physician reimbursement under Medicare should not be tied legislatively to ICD-10 implementation.”

Rollercoaster Session Ends with Delay Vote

During the House vote debate this morning, several House representatives mentioned that H.R. 4302 included provisions unrelated to SGR that likely many members of Congress were unaware were included in the bill.

“Perhaps we ought to have a criteria of everybody who has read this bill can vote on it. My bet is there would be very few members who would be able to vote on this bill,” said Democratic Whip Representative Steny H. Hoyer (D-MD). “None of us know what the substance of this bill is… I challenge any member to come up here and say ‘I have read this bill.’”

During the House floor debate Thursday morning, House Minority Leader Representative Nancy Pelosi (D-CA) characterized the rushed manner in which the bill had been brought to the floor, with most representatives having no opportunity to see the bill before a vote, as a missed opportunity. “This would be a more appropriate debate a month ago, where the clock does not run out over the weekend. But this is a tactic, it’s a technique, used by the [Republican] majority to force the hand without the proper weighing of equities in all of it,” said Pelosi.

It remains unclear why the language to delay ICD-10 implementation until October 1, 2015 was added to H.R. 4302. The ICD-10 delay section was not a point of discussion during the House floor debate. The SGR has been an ongoing issue in Congress for a number of years and a permanent solution has yet to be passed. Instead, continuous SGR patches have been employed.

After 40 minutes of debate on the bill, H.R. 4302, and an inital call for a vote, House officials decided that a quorum was not present, and therefore a vote would not be conducted. Further proceedings on the motion were postponed while bill supporters met privately with members of the House to gain support for its passing.

Though a vote could have occurred without quorum if agreed upon by House representatives, Pitts, who introduced the bill, objected to a vote in the absence of quorum. This uncommon move is likely because the bill had strong objections from groups like the American Medical Association and members of Congress who are physicians, and bill supporters didn’t think they had enough votes, according to AHIMA’s Director of Congressional Relations Margarita Valdez, who has been monitoring congressional proceedings on ICD-10.

“This is a game unworthy of this institution and of the American people,” said Hoyer, regarding the lack of transparency in the bill’s development and rushed journey to the House floor. “It is unfortunate that we have been put in this position with less than 48 hours’ notice of what’s in this bill.”

Without formal warning, the bill was reintroduced Thursday afternoon and passed by a voice vote without quorum. The move excluded several members of the House from the vote, and made it impossible to know exactly who would have voted for or against the measure.

ICD-10 Proponents Warn of Harmful Implications of Another Delay

AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

In a letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner, members of the Coalition for ICD-10 said that CMS and other government officials should move forward with the current ICD-10 deadline of October 1, 2014. Coalition representatives include the American Hospital Association (AHA), the American Medical Informatics Association (AMIA), BlueCross BlueShield Association, the College of Healthcare Information Management Executives (CHIME), and vendors like 3M Health Information Systems and Siemens Health Services.

“Although many of the signatories to this letter were at odds over the timing of implementation when the National Committee on Vital and Health Statistics (NCVHS) and HHS embraced ICD-10—which has already been adopted outside the U.S. worldwide—we are now in agreement that any further delay or deviation from the October 1, 2014 compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending,” the letter reads. “By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing,” the letter stated.

“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients,” the letter continued. “Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”

The impact of another delay in ICD-10 would be far reaching across the healthcare industry, AHIMA officials said. Many healthcare education programs have been teaching ICD-10 exclusively to students in preparation for the October implementation, while healthcare organizations have invested time and money into preparing staff and systems for the switch.

Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

The call for a delay likely came as a surprise to CMS. On February 27, Tavenner announced at the Health Information and Management Systems Society Annual Conference that ICD-10 would not be delayed any further, stating “we have already delayed the adoption standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. There will be no change in the deadline for ICD-10.”

AHIMA Calls on Members to Request Removal of Delay Provision

AHIMA has put out a call to members and other stakeholders to contact their senators and ask them to take the ICD-10 provision out of the Senate’s version of the SGR bill.

When contacting congressional members, AHIMA has instructed callers to state that their senators should:

  • Oppose the specific language in the SGR patch legislation
  • Reach out to the Speaker of the House John Boehner and Senate Majority Leader Harry Reid to remove the ICD-10 language from the bill

CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ”This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,” AHIMA wrote in a statement, which it encouraged its members to use when contacting Congressional representatives. “Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished…  Let Senate Majority Leader Reid and Chairman [Ron] Wyden know that a delay in ICD-10 will substantially increase total implementation costs in your district.”

Contacting Your Congressional Representatives

For more information on contacting your senators in Congress, visit AHIMA’s Advocacy and Public Policy representative look-up site at http://capwiz.com/ahima/dbq/officials/.

For more information on AHIMA ICD-10 advocacy, visit http://www.ahima.org/about/advocacy.