The questions are beginning to swirl around the announcement that Stage 2 and Stage 3 of Meaningful Use will be extended by a year. How will the delay affect competing initiatives like ICD-10? Will the longer reporting periods give providers some breathing room in 2014? Does the fact that CMS is bending on the timeline for meaningful use indicate that an ICD-10 deferral is in the cards? On first glance, it might look like the news changes everything. But does it?
Yes and no. While the extension does give later adopters some extra time to prepare for their initial attestation, it doesn’t help the providers who were planning to attest January 1, 2014. The start date is still the start date, which has already attracted complaints from heavy hitters like CHIME and HIMSS, and that means the confluence of Stage 2 and ICD-10 remains unaffected. The organizations have urged CMS to tackle what they see as the real problem: Stage 2 starts too soon, and not enough people will be ready.
“On many fronts, ICD-10 is a game changer, and we know there are some CIOs that aren’t necessarily ready,” Russell P. Branzell, President and CEO of CHIME, said to EHRintelligence. “So what we want to do is make sure that they can devote the required attention to it. The question is whether they can also resource Meaningful Use Stage 2, which is a significant challenge. That’s why we asked for the flexibility [in the start date].”
“Without flexibility, we foresee increased risk to numerous concurrent programs, especially to ICD-10,” added CHIME Board Chair George T. Hickman in an open letter to HHS. “With ICD-10 compliance, the HIPAA Omnibus Rule requirements, and payment reform under the Affordable Care Act and Meaningful Use all converging in 2014, providers are nearing a breaking point. Due to these concurrent mandates and resource constraints, numerous providers have already indicated they will not pursue Meaningful Use Stage 2 in 2014.”
Providers may still have the option not to participate in Meaningful Use, but they don’t have a choice as to whether or not to comply with ICD-10. The federal mandate is simply not optional if providers want to continue to get paid for their services, and that’s probably not going to change. ICD-10 has already seen one significant delay, and CMS has repeated time and again over the last six months that October of 2014 is the real deal. Pride, if nothing else, might keep CMS from bowing out on ICD-10 just after admitting that its ambitious timeline for EHR adoption is untenable.
But nothing is set in stone until after it happens, and last-minute changes and turnarounds seem to be HHS’ modus operandi. CMS has recently started to awaken to the need for more testing between providers and Medicare, with its planned testing week in March, which may signal the beginning of an acknowledgement that the industry is woefully unprepared to succeed in 2014. So far, CMS has focused only on the need to prepare and little on the necessity of contingency planning, which may not be a smart move as we creep closer to the implementation date with only questionable progress industry-wide.
“The industry as a whole is kind of waiting to see what CMS has been talking about for the last couple of months,” says Erik Newlin, Director of National Standards Consulting in Xerox’s Government Healthcare Solutions Group and Co-Chair of the ICD-10 Transition Workgroup at WEDI. “Specifically, there’s going to be a series of – not just recommendations. It’s basically a platform of expectation for testing. We’re weeks away from that guidance being released, not months.”
“I think you’ll find payers that have been fundamentally ready,” he told EHRintelligence. “Some payers were fundamentally done well in advance of the original date. They’ve made their heavy code changes. They had their policy basically ready, and they’re in the process of kind of dusting that off. Now they’re now questioning the readiness externally. Do they have to do something differently since other people aren’t ready? There are certainly payers that are not as far along as perhaps they would like to be so, I think what I see across industry is folks across the entire spectrum.”
