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Opinion: Anger, Disappointment, and a Collective Sigh of Relief

in  keynotes  

I have a friend who says, "We have to deal with the world the way it is, not the way we want it to be." By now everyone who pays attention knows that the unpredictable and chaotic kerfuffle that gave us the "Protecting Access to Medicare Act of 2014" unceremoniously concluded with President Obama's signature Tuesday afternoon. The legislation, among other things, patches the SGR for another year and delays ICD-10 implementation until October 1, 2015. Only the sound of crickets chirping can be heard at CMS, where repeated announcements strongly enforcing the imminent deadline of ICD-10 continued the very morning of March 27, right before the House vote.

A lot of people are downright angry.  Consider that only six weeks ago there was bipartisan agreement on a permanent repeal and replace of SGR. Then Republicans attached a provision that would delay enforcement of the Affordable Care Act's individual mandate penalties, effectively killing the bill. Ironically, last week the Obama Administration announced its own reprieve of the individual mandate penalty. Individuals who claim they had difficulty signing up will not be penalized. John Boehner must be a horrible chess player. The net result is that providers still have looming cuts hanging over their heads, and in a year we will likely go through this again.

The ICD-10 delay is another matter.  Providers, practices, hospitals, clearinghouses, re-pricers, software vendors, and medical coders have logged untold hours and millions of dollars in preparation for the phantom October 1, 2014 go-live date. When the Obama administration repeatedly announced there would be no delay in ICD-10 implementation the healthcare industry believed them, committing significant resources to preparation. The financial cost and lost productivity already incurred is immense, and will in many cases have to be repeated as knowledge atrophies from lack of use. Add to that the opportunity costs of miss-allocating resources and the price of vacillation in Washington becomes staggering.

Still, I can't help but feel we may have dodged a bullet.

Given the ACA go-live debacle and CMS's extremely limited end-to-end testing of ICD-10, it is well within the bounds of rationality to expect the whole thing would crash and burn should the 2014 date been reality, despite the best efforts of many of us whose livelihood depends on a reimbursement system that works (well, works most of the time).  Think of the ICD-10 delay as a kind of reprieve for those in healthcare who chose to ignore the 2013 and 2014 deadlines. (Somewhere a kid is yelling, "Wolf!")

So, let's deal with the world we live in.  Everyone pause and give thanks, then continue the hard work of moving healthcare forward. ICD-10 is still coming and challenges to fair reimbursement are greater than ever before. Back to work everybody.



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