The U.S. Department of Health and Human Services (HHS) will be giving health insurers, doctors, hospitals and others more time to shift to a new set of diagnosis codes.
HHS Secretary Kathleen Sebelius has announced that the department will push back the date when affected health care entities have to move to the International Classification of Diseases, 10th Edition (ICD-10).
Federal health care laws and regulations that came along years before passage of the Patient Protection and Affordable Care Act of 2010 (PPACA) were going to require health care organizations to make the shift by Oct. 1, 2013.
Sebelius did not say what the new compliance date will be, but she said HHS will work with health care providers to reexamine the pace of the shift.
Health care organizations in the United States and in many other countries use ICD codes to administer just about every aspect of health care administration and finance. Shifting will require changes in medical office procedures, medical billing systems, plan administration systems and insurance company systems, HHS officials say.
U.S. health care organizations have been using an older diagnostic code system, ICD-9, for years.
America's Health Insurance Plans (AHIP), Washington, has estimated shifting to ICD-10 from ICD-9 will cost its health plan members about $12 per plan enrollee, or a total of about $3 billion industrywide.
The American Medical Association, Chicago, has been pleading for the government to stop the ICD-10 conversion effort altogether, saying its members are feeling overwhelmed by the cost and complexity of the shift.
The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.
But many health policy experts have argued that the United States should shift to the ICD-10 system, which was developed by the World Health Organization, as quickly as possible, in an effort to expand access to the kinds of detailed, comprehensive information needed to track health trends and determine whether new treatments and care management strategies are helping patients or hurting them.
"ICD-10 codes are important to many positive improvements in our health care system," Sebelius said in a statement about the decision to postpone the shift.
One reason to update the diagnostic code system is that modernizing will help the United States do a better job of comparing its health care data with data from the rest of the world, Sebelius said.
The Healthcare Information Management and Systems Society (HIMMS), Chicago, says it thinks the gains from at least making large health care organizations shift to ICD-10 by the original Oct. 1, 2013, deadline outweigh the costs.
About 90% of large health care providers have told HIMSS they can implement ICD-10 by Oct. 1, 2013, and about 67% say ICD-10 implementation has been their organizations' top financial IT priority, HIMSS says.
Although sticking to the Oct. 1, 2013, deadline could increase some kinds of costs, changing the deadline could lead to increases in other costs, HIMSS says.
"Examples of these costs include maintaining two separate systems, retaining the services of consultants for longer than anticipated, and re-training staff," HIMSS says.
The American Medical Association, Chicago, has welcomed news that the ICD-10 compliance date will be postponed.
"The timing of the ICD-10 transition could not be worse for physicians as they are spending significant financial and administrative resources implementing electronic health records in their practices and trying to comply with multiple quality and health information technology programs that include penalties for noncompliance," the AMA says in a statement.