Feds Delay Everything--Why Not ICD-10?

Over the past several weeks the federal government has postponed or delayed almost every major healthcare initiative save one–ICD-10.

Most, if not all, of those suspensions or interruptions have hurt or will hurt healthcare providers and made their jobs harder. Isn’t it about time to provide healthcare providers a little much-needed relief?

So far the federal government, be it the administration of President Barack Obama or the Congress, has yet to hit a significant deadline. Here’s a quick laundry list and its impact on those who provide healthcare:

Permanent solution to “doc-fix.” Leadership in Congress reached a long-in-gestating compromise to end the sustainable growth rate (SGR) formula that next week will cut physician reimbursement from Medicare by nearly one quarter. That compromise crumbled two weeks ago when House Republicans announced legislation to fund the compromise by postponing the individual mandate to get health insurance by five years. Now legislators are scrambling for another quick-fix (as they have done every year for the past 10) that almost certainly will get funded on the backs of healthcare providers (as it has every year for the past 10).

Hcalth insurance mandate. This has multiple parts:

• Postponing employer mandate. This decision will have multiple negative impacts on healthcare providers. First, one of the growing segments of bad debt are under-insureds, patients whose employers, to save costs, have instituted health insurance benefits with large deductibles, co-pays, and co-insurance payments. Employers now get two additional years to shift the cost burden onto their employees, who in turn will in larger numbers fail to meet those financial obligations, creating more bad debt for healthcare providers.
• Extending inadequate health insurance. One of the benefits of the Affordable Care Act for healthcare providers was that it phased out inadequate insurance policies purchased by individuals. President Obama’s repeated promise that “If you like your insurance, you can keep it,” doomed that, and so healthcare providers will continue to be stuck with the bill from the underinsured.
• Allowing insurance mandate deadlines to slip. The debacle that was the launch of Healthcare.gov forced the administration to ease the open enrollment deadline of Dec. 15 for Americans seeking insurance that would begin Jan. 1. While this move was a positive for healthcare providers in that it gave patients extra time to obtain insurance, it created and continues to create administrative challenges for providers who have to sort out who has insurance and who does not. Now this week the administration has announced that the March 31 cutoff date for open enrollment to get any insurance for 2014 will be extended up to two weeks for anyone who claims to have had an issue attempting to sign up before that date.

RAC appeal delay. The Administrative Law Judges announced they have an almost two-year backlog of appeals of RAC decisions (of which more than 40 percent in recent years have been overturned), and as a result put a 2-year moratorium on new appeals. For healthcare providers, this means they Medicare reimbursements either waiting for appeal or waiting to be appealed will be tied up even longer. Hundreds of millions of dollars may grow into billions of dollars owed providers.

IRS 501(r) regulations unresolved. Even though the agency has had more than 18 months to finalize regulations covering how non-profit hospitals can or cannot collect patient debt, the Internal Revenue Service was unable to to get the job done and punted at the end of last year by announcing that the draft regulations would be enforced until the new regulations were completed. The proposed regulations constrain how not-for-profit providers collect bills from patients. Expect bad debt to grow.

To be fair there have been other delays by the federal government that have worked in favor of healthcare providers, such as the decision by CMS to protect the new two-midnight rule from RAC review for a year. However most of these delays have come at the expense of healthcare providers and the aggregated impacts are only now beginning to be felt. The worst will come in the next few months, just in time for implementation of the most expensive of all regulatory changes, ICD-10.

The harsh reality is that healthcare providers have too much on their plate, and one more dramatic change may be too much. Postponements and delays are the new normal for the federal government, particularly in this age where the nation is attempting to reform healthcare. Would one more delay be too much to ask?