The bill, which delays implementation until at least October 2015, passed the House on Thursday and a Senate vote is expected Monday.

“We put a ton of effort into preparing for ICD-10,” said Dr. Brian Patty, chief medical information officer at four-hospital HealthEast Care System, St. Paul, Minn. “We've had our ICD-10 steering committee up and running for two years.”

At immediate risk are contracts the system has for extra coders for case review and to convert ICD-9 codes from an ambulatory electronic health record running on ICD-9 that's being phased out and won't be replaced until next year.

“That's literally about a half a million dollars for various contractors to cover us when we go up on ICD-10,” Patty said.

But what may be worse—if the delay goes into effect—is its impact on relationships with affiliated physicians, who comprise about four-fifths of the medical staff.

“We just began training all of our physicians with online training about a month ago,” Patty said. About 200 have completed two to four hours of training, which will have to be repeated next year if the delay goes into effect, he said.

The program began despite skepticism the government might again—as it did in 2012—delay ICD-10 implementation, Patty said.

“Come a year from now, are they going to balk and say, 'That's what you said last time?' ” Patty said.

“I think that the lost good will we've had with our providers will be the biggest hit,” he said.

Prolonging the switch would delay the use of more detailed codes that would more accurately reflect the severity of illnesses and any additional complications or conditions, changes that are needed as providers enter into population health efforts and risk-based payments, said Dr. Frank Byrne, president of St. Mary's Hospital in Madison, Wis.

Byrne called the proposed delay disappointing "notwithstanding the prodigious amount of work yet to be done to get ready for ICD-10." The new codes' improved accuracy is "essential to the transition of healthcare payments from volume to value," he said.

But other healthcare providers, struggling to get ready for a challenge likened to the Y2K of healthcare, welcomed a delay.

Home health clinical manager Diane Glasgow with the Covenant Healthcare Visiting Nurse Association in Saginaw, Mich., called another year to train helpful. Similarly, Terry Gunn, CEO of KershawHealth, said having more time to make the switch to ICD-10 would be a boon for the Camden, S.C.-based hospital. "It's a huge, overwhelming task," Gunn said.

The delay provision is contained in a single sentence of the 123-page bill out of the House Ways and Means Committee, the bulk of which would provide what has become the annual last-minute doc fix to the physician sustainable growth-rate formula.

On Monday, a group of healthcare industry heavyweights called the Coalition for ICD-10 that includes the American Hospital Association and the Blue Cross and Blue Shield Association, opposed the provision.

“The Blues plans are on track to be ready,” said Justine Handelman, vice president of legislative and regulatory policy at the Blue Cross and Blue Shield Association. “We've been working hard. We and our plans will make sure we make our position known that we want to move ahead without further delays.”

The American Medical Association and the Medical Group Management Association have long lobbied for an ICD-10 delay.

“The government has done a woefully inadequate job explaining the return on investment to providers,” said Robert Tennant, MGMA senior policy adviser. “There's no recognition of the tremendous cost and disruption this transition will lead to, including the lost productivity to clinicians and coders.”

A chunk of the federal government's own credibility is at stake in the ICD-10 debate. Throughout 2011, when the ICD-10 conversion date was Oct. 1, 2013, federal officials were adamant that the deadline would hold—until they weren't. In February 2012, HHS Secretary Kathleen Sebelius and then-acting CMS Administrator Marilyn Tavenner threw their own timeline under the bus, granting a one-year extension to the current compliance date.

As recently as last month, Tavenner told an expectant crowd at her keynote speech during the annual Healthcare Information and Management Systems Society convention in Orlando, Fla., that there would be no more budging, ICD-10 would go into effect Oct. 1.

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