Monthly Archives: March 2014

Newsflash: House Approves Bill That Includes Delay to ICD-10 Date. What Does This All Mean?



A resolution in the House of Representatives passed this morning which contains language that delays the compliance date of ICD-10 by one year to 10/1/15.  This primary intention of this legislation was to offer a 1 year extension to the expected Sustainable Growth Rate (SGR) formula change that was set to reduce Medicare provider reimbursement by 24% beginning April 1.  Within this, a Republican Representative Joe Pitts from Pennsylvania inserted a 7 line section that states that HHS cannot effectively enforcement the adoption of the ICD-10 code set prior to 10/1/15.  As you can see, this ICD-10 delay has no direct correlation w/the intent of the original House measure.  (The Senate has a similar measure that has not yet been recorded and does not have a vote scheduled as of date).  It is also unclear why Representative Pitt inserted this particular language into this specific legislation.

Have you all picked your jaw off the ground yet???

What’s noteworthy here is that almost all of the major physician organizations including the American Medical Association is against the bill, especially the Medicare SGR patch.  So far, the physician groups have been silent on the ICD-10 portion of the bill.  They don’t want yet another 1 year delay in the SGR but real and meaningful change to the formula.  They see the delay as yet another stop/gap measure that will keep occurring year after year until the formula is modified in earnest.  Not surprisingly, AHIMA and other HIM groups are not happy with this measure and are actively encouraging their member constituents to contact their legislators and urge them to vote no.  However, as stated previously, this measure did in fact pass the House this morning.  (Read here for more information regarding how the vote was conducted–it broke from normal rules of conduct).

Before we all go into panic mode as to what this means for our current ICD-10 implementations, let’s take a step back and understand the mechanics of how a piece of legislation becomes a law.  This should be able to put some of this into perspective and give us a better focus on what this all might mean to us.  (Cue ‘School House Rock’ music…….)  Bill

Step 1:  A bill (or resolution) is introduced into a chamber of Congress, either the House of Representatives or the Senate.  There’s a whole bunch of stuff that occurs such as committee and subcommittee meetings, negotiations, studies performed, public hearings held, and then scheduling floor action, debate, and then a vote.  (You can see further detailed information regarding the overall legislation process here).  If the legislation is passed w/a majority vote, it gets referred to the other chamber in Congress.  Since this legislation passed, it continues onto step 2.

Step 2:  This approved legislation is sent to the other chamber where it can undergo the same steps as performed in the first chamber—subcommittee meetings, negotiations, studies, and public hearings.  They can then choose to mark this as received, ignored, changed, or approved.  If there are changes, even minor ones, from the original legislation, it must be reviewed by a Conference Committee composed of negotiators from both chambers in order to reach an agreement.  if an agreement cannot be reached, the legislation dies.  If an agreement is reached, it has to go back to both chambers w/the agreed upon modifications (called a Conference Report) and be approved.

Step 3: If the identical bill passes both chambers of Congress,  it is then sent to the President’s desk for signature if he agrees to the bill.  The President may also choose to not sign it for up to 10 days while Congress is in session and it de facto becomes a law; veto it and members of Congress can attempt to override the veto by a 2/3 vote; or let the bill die if he takes no action while Congress is not in session.

I would just caution everyone to take this w/a grain of salt, at least for now.  There are a lot more hurdles that must be overcome before ICD-10 is officially delayed yet again.  This is by no means a done deal.

Coming to Your Next Doctor’s Visit: Google Glass…..

By now, Google Glass has made its way into (some of) our vocabularies.  While this is still in a beta mode with a very limited number of users, there is already a company that has developed an application that they are hoping will help facilitate the doctor-patient interaction that will benefit both parties.  Augmedix is a hands-free Google Glass application that captures clinical documentation seamlessly at the end of the visit through a video and audio stream.

Pretty cool, eh?

Another feature capitalizes on the Google Glass’ ability to intertwine the web seamlessly with the user and display the results on the user’s field of vision on the glass itself.  One thought with this application is that the clinician can query the patient’s, say, last blood pressure measurements through a voice command on the eyewear itself (much like OnStar integrated into GM cars) and the results will be returned instantaneously to the wearer of the Google Glass unit.

Is your mind completely blown, now?

The Name Game?

A few months ago, I was waiting for an appointment at my local spa when I happened to notice the receptionist was on on her computer.  Having following the rollout of the Affordable Care Act w/great earnest, I couldn’t help but asking her if she was shopping for health insurance through the new government exchange.  She said she was.  Further into the conversation, she expressed a feeling of confusion and being overwhelmed at how to even shop among the different plans being offered to her.  Even w/all my years in the health insurance world, it was a bit challenging for me to decipher what one payer’s ‘Open Access’ meant versus another plan’s ‘Blue Choice’ meant as far as coverage and options.  I had to head into my appointment so I never found out which plan she decided to choose.

A New York Times article highlights the confusion in the following article.


CMS Version of Cliff Notes for ICD-10 Small Physician Practice Implementations

The road to ICD-10 for engaging small physician practices has been just like dragging a horse to water.  (Apologies to any horses that might be offended with this analogy).

As mentioned in a blog post a few weeks ago, the American Medical Association has lodged yet another protest to HHS Secretary Sebelius on why the march towards the ICD-10 compliance date of 10/1/14 should be halted.  Recently (I first noticed it the middle of last week), a CMS-funded website was launched,, that provides great information to help with a small physician practice jump-start their ICD-10 implementation activities.  It is much more concise and spells out in layman’s terms, in my humble opinion, how and where ICD-10 will impact them.

It gives information such as:

1) The most generally used codes by physician practice both in ICD-9 and the ICD-10 equivalents

2) Clinical documentation considerations by specialty

3) Resource links to CMS, AHIMA, and AAPC for further information and training