© 2014

ICD-10: A Legislative Review

Presenter:

Margarita L. Valdez, Director,

Congressional Relations

Special Guest:

Sue Bowman, Senior Director,

Coding Policy and Compliance

Webinars • The ICD-10 Legislative Review webinar will

recap the legislative events that led to a delay. The goal is to understand the legislative process and provide information on the next steps in advocacy.

• The next webinar is scheduled for Friday, April 11 NOON CST/1:00 EST . It will cover CEUs, exams and other FAQs.

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Agenda

• What is SGR?

• H.R. 4302

• House Votes

• Senate Votes

• Results

• Next Steps

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What is the Sustainable Growth Rate?

• The Sustainable Growth Rate (SGR) formula is a budget cap passed into law in 1997 to control physician spending.

• Since 2003, Congress has spent nearly $150 billion in short term

patches to avoid unsustainable cuts imposed by the current SGR. The most recent patch was set to expire on March 31, 2014.

• Building on bipartisan legislation unanimously reported out of the

House Energy & Commerce and Ways & Means Committees, and reported out of the Senate Finance Committee, the unified legislation from the three committees would have repealed the SGR.

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SGR Repeal and Medicare Provider Payment Modernization Act of 2014 • Announced February 6, 2014

• Bipartisan, bicameral proposal would have ended the annual ‘Doc Fix’ crises – Senate Finance Committee – House Ways and Means Committee – House Energy and Commerce Committee

• The legislation from the three committees would have repealed the SGR and transitioned Medicare away from a volume-based system towards one based on value. – Provide stability and 5 years of payment updates – Create a system focused on quality, value, and accountability.

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Breakdown in Negotiations

“The opposition stems from the bipartisan effort over the past few months to pass a permanent repeal of SGR and end the years of emergency patches and the constant threat of physician pay cuts.”

“But the House-Senate negotiations over how to pay for it

stalled. And the latest “doc fix” expires on Monday — a timeline that prompted the House to move ahead on a patch to prevent a cut to physician payments on April 1.”

- Politico 3/26/2014

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What’s the Connection Between SGR and ICD-10?

• The most recent patch was set to expire on March 31, 2014.

• Since legislators could not agree on how to pay for a permanent fix, bipartisan, bicameral Leadership opted for a 1-year “patch”

• The American Medical Association, American College of Physicians, American College of Surgeons, American Osteopathic Association and American Academy of Family Physicians, etc. all opposed another “patch”

• ICD-10 was added as a carrot, along with several other provisions, to appease opposition- it didn’t work

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H.R. 4302, Protecting Access to Medicare Act of 2014 Section 212

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www.thomas.gov

H.R. 4302

• The bill was introduced at midnight on Tuesday, March 25 in the US House of Representatives

• 1-year patch for SGR

• Section 212 included a delay to ICD-10

• The bill was placed on the Suspension Calendar

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House Suspension of the Rules?

• Suspension of the rules is a procedure the House of Representatives uses frequently to debate and pass measures on the floor. It can be used on Mondays, Tuesdays, Wednesdays and the last 6 days of session.

• The Speaker determines which suspension motions the House will consider. Members offering suspension motions are recognized at the discretion of the Speaker.

• No floor amendments to the bill are required. However, the Member who offers the suspension motion may include amendments to the bill. In this case, the Member moves to suspend the rules and pass the bill or resolution as amended.

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House Suspension of the Rules

• After a Representative moves to suspend the rules and pass a particular measure, there can be 40 minutes of debate on the motion and the measure.

• At the end of the 40 minutes of debate, the House casts a single vote on suspending the rules and passing the measure. There is no separate vote on the measure or on any of the amendments to it that are included in the suspension motion.

• Each suspension motion requires a vote of two-thirds of the Members present and voting, a quorum being present.

• This is different than a “roll call” vote which requires a simply majority of 218, and is recorded electronically.

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Voting and Quorum Calls

To conduct a voice vote the Chair puts the question: ''As many as are in favor say 'Aye'. As many as are opposed, say 'No'. '' The Chair determines the result on a comparison of the volume of ayes and noes.

This is the form in which the vote is ordinarily taken in the first instance. If any Member requests a recorded vote and that request is supported by at least one-fifth of a quorum of the House (44 Members), the vote is taken by electronic device.

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Voting Timeline in the House March 27,2014

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Timing of the Vote 3/27/2014

• The House was in recess for an undetermined amount of time

• Members express outrage that they were not given proper notice of the vote on H.R. 4302

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Legislators React to the Vote News Reports

• Rep. Louie Gohmert (R-Texas) on Thursday blasted a decision by House leaders to voice vote a controversial Medicare bill, and said he and other like-minded members would monitor the House floor at all times to ensure it can't happen again. –The Hill

• No one had the chance to vote no; no one had a chance to vote yes. The maneuver came after a long delay amid opposition that threatened to kill the bill… -Politico

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Legislators React to the Vote News Reports

• The fast-track “doc-fix” legislation was based a bipartisan deal struck between House Speaker John Boehner and Senate Majority Leader Harry Reid. -Health and Data Management

• Members of both parties told the press last week that they were angry leadership passed the “doc fix” by voice vote when it was clear there were not enough votes to pass it on a roll call. -Roll Call

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The bill moved to the US Senate

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US Senate Considered H.R.4302

• 3 hours of debate were allotted to the bill

• Senator Wyden (OR) attempted to introduce an alternative bill to the SGR patch

• At 6:31 pm ET H.R. 4302 passed. The final vote was 64-35 – Some news outlets incorrectly reported the vote on the budget points

of order against the bill

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How did Your Senator Vote? www.senate.gov

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Legislative Timeline

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Sec. 212. Delay in transition from ICD-9 to ICD-10 code sets

“The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d-2(c)) and section 162.1002 of title 45, Code of Federal Regulations.”

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Signed into Law on April 1, 2014

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Educating Capitol Hill on ICD-10 • Over 35,000 AHIMA members saw the action alert

• 10,000 recorded calls through the advocacy assistant – The total number is most likely much higher with those who used the script

from the special e-alerts

• 6, 000 “LIKED” the alert on Facebook

• Over 5,500 #NoDelay Tweets

• Over 1,000 letters sent from the advocacy assistant

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Coalition for ICD-10 Implementation Contacting Leaders & Next Steps

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http://coalitionforicd10.wordpress.com/

Coalition for ICD-10 Members Advanced Medical Technology Association (AdvaMed)

American Health Information Management Association (AHIMA)

America’s Health Insurance Plans (AHIP)

American Hospital Association

American Medical Informatics Association (AMIA)

BlueCross BlueShield Association

College of Healthcare Information Management Executives (CHIME)

Health IT Now Coalition

Medical Device Manufacturers Association (MDMA)

3M Health Information Systems

Roche Diagnostics Corporation

Siemens Health Services

WellPoint

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http://coalitionforicd10.wordpress.com/

Next Steps: Advocacy Assistant

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Website: http://capwiz.com/ahima/home/

Advocacy Assistant

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Capitol Hill FAQs Q: What investments have been made into transitioning to ICD-10? A: Share the specific costs and efforts that you have made. Make your responses specific to your Congressional district and

home state. Q: Who has to comply with ICD-10? A: All HIPAA-covered entities must convert to ICD-10-CM for reporting diagnoses and ICD-10-PCS for facility reporting of

hospital inpatient services, from the 35 year old ICD-9-CM version. Q: Why does the US need to replace ICD-9-CM/PCS? A: Developed in the 1970s, the ICD-9-CM code set no longer fits with the 21st century healthcare system. ICD-9-CM is used for

many more purposes today than when it was originally developed and is no longer able to support current health information needs.

Q: Has the pace of the ICD-10 transition been too rapid? A: For the past 14 years, healthcare organizations have known that ICD-10 implementation would occur. This provided plenty

of time to prepare for the transition. The longer implementation takes, the more it will cost and the more the quality of healthcare data will suffer.

Q: Why is it important not to delay the implementation of ICD-10? A: ICD-10-CM and ICD-10-PCS must be adopted as soon as possible to reverse the trend of deteriorating health data. Never in

US history have we used the same version of ICD for 35 years. Q: Will ICD-10 procedure codes be used for both inpatient and outpatient hospital services? A: No. ICD-10 procedure codes are designed only for hospital reporting of inpatient services. CPT codes will continue to be

used for physician and outpatient services.

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FAQs Continued… Q: Do physicians need to use all the codes in ICD-10?

A: Healthcare providers will not use all the codes in the classification; rather they will use a subset of codes based on their practice. The ICD-10-CM code set is like a dictionary that has thousands of words, but individuals use some words very commonly while other words are never used.

Q: Does ICD-10 compete with other healthcare initiatives that require time and resources to implement?

A: No. The industry has had 14 years to prepare for the implementation. The benefits of ICD-10 will improve national healthcare initiatives such as Meaningful Use, value-based purchasing, payment reform and quality reporting. Without ICD-10 data, there will be serious gaps in the ability to extract important patient health information needed to support modern-day research, and move to a payment system based on quality and outcomes.

Q: What is the value of ICD-10?

A: The improved clinical detail, better capture of medical technology, up-to-date terminology, and more flexible structure will result in:

• Higher quality information for measuring healthcare service quality, safety, and efficiency

• Improved efficiencies and lower costs

• Greater coding accuracy and specificity

• Greater achievement of the benefits of electronic health records

• Recognition of advances in medicine and technology

• Improved ability to measure outcomes, efficacy, and costs of new medical technology

• Better support of medical necessity of services provided

• Fewer claims denials

• Improved ability to determine disease severity for risk and severity adjustment

• Global healthcare data comparability

• Improved ability to track and respond to public health threats

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Questions?

Contact: Sue Bowman at: sue.bowman@ahima.org

Margarita L. Valdez at: margarita.valdez@ahima.org

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