What the ACA Supreme Court ruling means for health IT

President Barack Obama's hallmark health insurance legislation, the Affordable Care Act, has been affirmed by the U.S. Supreme Court in a recent ruling. This piece of legislation that was signed into law in 2010 has been causing political and regulatory rifts ever since, but the affirmation of legal subsidies will now allow patients to move forward with the consumer protections passed several years ago.

These subsidies are very important, according to Health Data Management. Without them, much of the ACA would have been null and void. In short, these provisions and health insurance exchanges are aimed to keep things more transparent and fair between patients and insurance companies. However, the ACA also has an impact on the progression of health IT.

The ACA effect
Health Data Management point out that after this Supreme Court decision, several health IT policies will remain in place, including statewide health insurance exchanges and HIPAA electronic claims with electronic health records (remittance advice and claims attachments would also be included in these).

Additionally, a health plan identifier will continue to be part of the policy, as would electronic capabilities for enrollment into health and human services programs like Medicare and Medicaid. Obamacare also imposes a tax on health IT devices, including tools that collect or share patient data. Lastly, the ACA helped to expand data analytics further, especially in regards to Medicare claims data.

The Supreme Court's decision has a direct impact on the future of health IT.
The Supreme Court's decision has a direct impact on the future of health IT.

In a 6-3 ruling on King v. Burwell, the dissenters were justices Antonin Scalia, Clarence Thomas and Samuel Alito. Their main concerns with the ACA pertain to a half-phrase in the legislation concerning limited subsidies to states that operated their own exchanges. The majority of the judges, however, claimed that the half-phrase in question was not literal.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B (pertaining to subsidies) can fairly be read consistent with what we see as Congress's plan, and that is the reading we adopt," the judges in favor of the ruling stated.

Reactions from organizations
According to Healthcare IT News, several leading medical organizations, including the American Medical Association, the Mayo Clinic and the Department of Health and Human Services all expressed relief at the decision, both in terms of public health and health care costs.

Even though this is the second time the ACA has gone through Supreme Court trials, legislators against the ACA have vowed to repeal Obamacare, even though President Obama still holds executive power and the right of veto. Whether or not political posturing will continue with an election year coming up remains to be seen. However, in the meantime, the ACA's provisions regarding health IT expansion and optimization are still expected to progress and advance in addition to health insurance reforms.  

Is ICD-10 compliance still in reach?

As the October deadline for ICD-10 implementation nears, some providers might be concerned they are not prepared for the necessary code changes. There are signs that for most medical professionals and providers, this may very well be the case.

According to June 17 results of an eHealth Initiative survey that was conducted with help from the American Health Information Management Association, less than one-quarter of practices (17 percent) indicated that they had tested ICD-10 codes with payers and clearinghouses. Just 5 percent stated that they completed internal testing.

As for training, the results were a little more promising, with 41 percent stating that they had advised staff on the coding shift. Another 36 percent said that they had invested in tech upgrades to prepare for the shift. Still, there is clearly more room for improvement.

Running out of time
Health Data Management pointed out recently that as a result of the low ICD-10 attestation numbers thus far, several state medical societies, including those from California, Florida, New York and Texas, have stated that there is a "looming disaster" awaiting come October.

Although these numbers might seem bleak, the Centers for Medicare & Medicaid Services indicated that there is still time for providers to get on board with the ICD-10 code switch.

"Certainly, there is still time to get ready," deputy director of the National Standards Group, Denesecia Green, said during a June 18 Medicare Learning Network webinar, according to Health Data Management. Green, however, gave some words of caution: "It's definitely time to transition now."

Green also broke down a transition plan for ICD-10 into five steps:

1. Creating a plan for the switch.

2. Staff training.

3. Giving your practice's workflow an update.

4. Having a discussion about ICD-10 with your vendors.

5. Conducting tests on your system's ICD-10 capabilities.

During the planning stages, Green said that it was best to run an internal report of the most frequently used codes in your practice – the top 25 should be a good place to start. During training, it is very important that every staff member – from your medical scribes to front office staff – knows where the organization stands.

There is still time for providers to prepare for ICD-10.
There is still time for providers to prepare for ICD-10.

If you are a specialist, this training becomes all the more important. According to the Centers for Disease Control and Prevention, thousands of new code sets differentiate between ICD-9 and ICD-10, and many of them will pertain to specialty care. These coding changes might be significant, but as the CDC points out, the U.S. is the only industrialized country that is still using ICD-9 for morbidity data.

In many ways, this shift will not only help gather more efficient data about patients, but it will also help bring the U.S. health care system into the 21st century. ICD-10 will also be much more specific and in-depth, and many new concepts will be added that weren't previously there, such as information about blood type, alcohol levels and under-dosing.

There might be a bit of breathing room for doctors during the first two years of ICD-10 implementation, especially on the financial side of things. Congress is currently considering a two-year grace period following the switch, so physicians might not be penalized for coding errors during this time. 

Even if providers might have gotten a slow start with the ICD-10 transition, there is still time for practices to get ready for the transition this fall. One way to ease into the switch is to make sure that your electronic health system and medical software is equipped to handle these regulatory changes. While training and testing is certainly important, you will want your tech tools to be able to handle the optimization of the switch as well.