Proposed SGR patch includes one-year ICD-10 delay

March 26, 2014

Legislation crafted to patch the controversial sustainable growth rate formula for another 12 months would also delay the transition to ICD-10 until October 2015.

Legislation crafted to patch the controversial sustainable growth rate (SGR) for another 12 months, would also delay the transition to the International Classification of Diseases-10th Revision (ICD-10) until October 2015.
 
The current SGR fix is set to expire March 31, which would mean a 24% reduction in Medicare payments to physicians. The latest 121-page bill being negotiated would extend the fix until March 2015.   
 
The bill states that the U.S. Department of Health and Human Services may not adopt ICD-10 as the standard for code sets until October 1, 2015, despite recent public comments by Centers for the Medicare and Medicaid Services (CMS) Administrator Marilynn Tavenner that there would be no delay to ICD-10.
 
CMS declined to comment on the bill because it is pending legislation.

Congress is expected to vote on the bill on Thursday.

The ICD-10 transition has been a major point of concern for physicians due to its scope and cost to implement. In recent months the American Medical Association (AMA) ramped up opposition to the ICD-10 transition, and petitioned CMS for a delay to the implementation of ICD-10.
 
According to the AMA, small practices can expect staggering costs ranging from $56,639 to $226,105 to implement the new code set. According to a February survey by the Medical Management Group Association, 79% of physicians report that they haven’t begun ICD-10 implementation, or were only “somewhat ready.”

Molly Cooke, MD, FACP, president, American College of PhysiciansMolly Cooke, MD, FACP, president of the American College of Physicians, said the college favors the delay. "The college has expressed concern at every opportunity about the implementation of ICD-10. I'm not sure the healthcare system loses a lot if we delay implementation for another year, and it certainly would give our members a bit of a breather."
 
Earlier this month, the Republican-led House passed a bill to repeal SGR and replace it with a formula that would calculate payments based on quality metrics. But the bill received widespread opposition from Democrats because it was paid for by a five-year delay in the individual mandate in the Affordable Care Act (ACA).

Medical Economics will be updating this story as it develops.