Monday, September 8, 2008

HHS Ignores Advice It Asked For

In the Notice of Proposed Rulemaking or NPRM (warning: pdf) to mandate a switch to ICD-10-CM from ICD-9-CM for classifying diagnoses, the Department of Health and Human Services (HHS) mentions, on page number 49802 (the rule is in the Federal Register), that the Workgroup on Electronic Data Interchange (WEDI) sent the Secretary of HHS a letter on May 31, 2006.

The mention of this letter is significant because:

1. HHS is required by law to consult with WEDI on adoption of new code sets.
2. WEDI held a forum in April of 2006 to determine when and how to adopt ICD-10-CM.
3. The rule makes no mention of the recommendations of this letter.
4. The rule makes recommendations that directly conflict with the recommendations in the letter.

Perhaps Congress requires HHS to consult with WEDI because it recognizes that bureaucrats are wont to run roughshod over industry. If so, the NPRM is a good example of just such bureaucratic tendencies.

The official letter that WEDI sent to the Secretary of HHS is not available publicly: one must have a login to the WEDI web site to access it. Nevertheless, there are two publicly available documents that summarize the recommendations:

1. Co-Chair Report on ICD-10 Forum Discussion (warning: pdf)
2. WEDI ICD 10 Forum Recommendation to HHS Final Draft (warning: pdf)

We don't know if the latter truly represents the version that WEDI sent to the Secretary. For one thing, it does not even have a date.

However, the key recommendations from both documents are the same, and they are clear.

One recommendation that HHS blatantly ignores in its NPRM (it does not even mention the recommendation, let alone try to rebut it), is that implementation of another standard--known as 5010--should occur first. The NPRM requires that the industry adopt 5010 and ICD-10-CM concurrently, but that 5010 is required by April 1, 2010 and ICD-10-CM is not required until October 1, 2011.

Now it may seem that 5010 precedes ICD-10-CM. However, to meet those deadlines, the industry will have to start working on both standards now, and thus work on them concurrently.

The WEDI recommendation clearly states: This upgrade [to 5010] is too significant to be done in conjunction with ICD-10-CM and ICD-10-PCS conversion.

No wonder HHS doesn't mention this recommendation in the NPRM. It is too inconvenient. And it is too compelling to confront directly.

In a story about the effect of implementing 5010, the Blue Cross and Blue Shield Association notes that 5010 makes 850 complex changes to its predecessor standard.

Also, in 2007 WEDI and the North Carolina Healthcare Information and Communications Alliance (NCHICA) developed a detailed project plan that outlines all the steps the industry must take and milestones it must meet to adopt 5010. They derived a date of 2014 for final implementation of 5010 without ICD-10.

Yet HHS wants to adopt 5010 and ICD-10-CM by 2011?

WEDI is holding a policy advisory group forum from September 9-11 (just after this post) to address the ramifications of the NPRM on 5010 and ICD-10-CM. Let's hope they take HHS to task for ignoring the advice they gave it--advice that HHS by law is required to take into account.

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