Frustration Grows with SGR Fix, ICD-10 Transition


Congress has once again delayed implementation of draconian Medicare cuts tied to the sustainable growth rate (SGR) formula, but this time, the vote by lawmakers to patch the ailing physician reimbursement program rather than scrap it also pushes back the pending debut of ICD-10.

And that's frustrating some hospitalists.

"For about 12 hours, I felt relief about the ICD-10 and then I just realized, it's still coming, presumably," says John Nelson, MD, MHM, a co-founder and past president of SHM and medical director of the hospitalist practice at Overlake Hospital in Bellevue, Wash. "[It's] like a patient who needs surgery and finds out it's canceled for the day and he'll have it tomorrow. Well, that's good for right now, but [he] still has to face this eventually."

The SGR extension through year's end means that physicians do not face a 24% cut to physician payments under Medicare. The delay in transitioning healthcare providers from the ICD-9 medical coding classification system to the more complicated ICD-10 could mean the upgraded system may not go into effect until at least Oct. 1, 2015. This comes after the Centers for Medicare & Medicaid Services already pushed back the original implementation date for ICD-10 by one year.

SHM Public Policy Committee member Joshua Lenchus, DO, RPh, SFHM, says he expects the majority of doctors to be content with the delay, particularly in light of some estimates that show only 20% or so of physicians "have actually initiated the ICD-10 transition," but that it's unfair to those health systems that have prepared.

"ICD-9 has a little more than 14,000 diagnostic codes and nearly 4,000 procedural codes. That is to be contrasted to ICD-10, which has more than 68,000 diagnostic codes...and over 72,000 procedural codes," Dr. Lenchus writes in an e-mail to The Hospitalist's eWire. "So, it is not surprising that many take solace in the delay."

"It's distressing and frustrating for hospitalists, but less disruptive than it might be for hospitals," Dr. Nelson says. "And, of course in some places, hospitalists may be the physician leads on ICD-10 efforts, so [they are] very much wrapped up in the problem of 'What do we do now?'"

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