Providers, payers and claims clearinghouses can look for no relief from the looming, Oct. 1 compliance deadline for the nationwide conversion to the ICD-10 family of diagnostic and procedural codes, the head of the CMS said Thursday. But some case-by-case exemptions will be made for providers having a tough time meeting their Stage 2 meaningful-use targets, she said.
“There are no more delays and the system will go live on Oct. 1,” Marilyn Tavenner said during her keynote address at the Healthcare Information and Management Systems Society convention in Orlando, Fla., Thursday. “Let's face it guys, we've delayed this several times and it's time to move on.”
Similarly, there will be no rollback of compliance dates for Stage 2, Tavenner said, despite considerable pressure being applied to the agency to further delay compliance dates and add flexibility to its “all or nothing” requirements to meet meaningful-use measures.
For eligible hospitals, the starting date for Stage 2 was Oct. 1, 2013. Those hospitals have only two starting dates left in the program, which operates on a fiscal year, to commence 90 consecutive days of meeting the meaningful-use criteria: April 1 and July 1, 2014.
Tavenner's comments triggered a quick, and apprehension-filled, response from the American Medical Association.
The AMA is deeply concerned that Medicare does not have a back-up plan if last minute testing demonstrates anticipated problems with this massive coding transition,” said AMA President Dr. Ardis Dee Hoven. “At the end of the day, sticking hard and fast to the ICD-10 deadline without a back-up plan to address disruptions in medical claims processing will hurt doctors and their patients.”
Many doctors are still awaiting software updates from vendors and risk not having sufficient time to test those updates when they finally do arrive, Dee Hoven pointed out. “Testing is needed to discover problems and resolve them prior to the go live date. The slightest glitch in the ICD-10 rollout could potentially cause a billion dollar back-log of medical claims that jeopardizes physician practices and disrupts patients' access to care,” she said.
Addressing Tavenner's comments of meaning use deadlines for EHR, Chantal Worzala director of policy, American Hospital Association, said in a statement, “The American Hospital Association is disappointed that CMS will not make changes to the timelines or provide additional flexibility in the meaningful use requirements. The AHA will work closely with the agency to ensure that the hardship exceptions protect hospitals from unwarranted penalties.”
“By surveying the nation's hospitals we know that as many as 40% of hospitals could be at risk of missing the 2014 certified EHR adoption and meaningful use requirements,” she said.
Physicians and other eligible professionals, whose EHR incentive programs operate on the calendar year, have a bit more time and three dates—the first days of April, July and October—to start their 90-day clocks.
Regarding Stage 2 of the electronic health-record incentive payment program, which requires providers to electronically exchange healthcare records with others, Tavenner explained that “interoperability is a key step to everything going forward,” particularly CMS' value-based payment programs.
CMS has been sensitive to providers' concerns, Tavenner said, pointing out that the Stage 2 and Stage 3 start dates each had previously been pushed back a year. “Now is the time for us to start moving forward,” she said.
But, she acknowledged that some providers and health IT vendors may have legitimate issues, such as the late delivery of tested and certified software, or EHR vendors going out of business, that might preclude them from achieving timely compliance with Stage 2.
In those instances, Tavenner said, the CMS is willing, on a case-by-case basis, to entertain applications for “hardship exemptions.” Even with the exemptions, she said, CMS expects all Stage 2 providers to fully meet all Stage 2 criteria by 2015 while still encouraging everyone else eligible to meet them this year.