Senate approves SGR patch, ICD-10 delay

March 31, 2014

The Senate has passed a one-year patch to the Sustainable Growth Rate formula and a one-year delay to the implementation of the ICD-10 coding system.

The Senate has passed a one-year patch to the Sustainable Growth Rate (SGR) formula and a one-year delay to the implementation of the International Classification of Diseases – 10th Revision (ICD-10) coding system.   

The 121-page bill, which is the 17th temporary fix to SGR, was passed just hours before the current patch expired at midnight on Monday. If Congress failed to reach a deal before the deadline, physicians would have seen a 24% cut to Medicare payments.

The bill, which the House passed on Thursday, now heads to President Barack Obama’s desk for his signature.

Physician advocate groups, including the American Medical Association (AMA) and the American Academy of Family Physicians (AAFP), vehemently opposed any temporary patch to SGR. 

"Congress has spent more taxpayer money on temporary patches than it would cost to solve the problem for good," AMA President Ardis Dee Hoven, MD, said in a written statement. "This bill perpetuates an environment of uncertainty for physicians, making it harder for them to implement new innovative systems to better coordinate care and improve quality of care for patients."

The AMA said it will continue to fight for a permanent SGR repeal this year.

However, the provision in the bill that delays ICD-10 until October 2015 has prompted mixed reactions.

In an article on the AAFP’s website, AAFP President Reid Blackwelder, MD, FAAFP, said the delay also gives the Centers for Medicare and Medicaid Services (CMS) more time to conduct claims testing with practices.

“We have long expressed serious concerns about ICD-10's functionality and the real potential for technical problems that could result in delayed payments for physicians,” said Blackwelder. “Any problems in processing payments would be especially devastating for solo and small family physician practices.”

The upgrade to the new code set poses a significant financial challenge for practices. A recent AMA study revealed that the estimated cost to small practices ranged from $56,639 to $226,105.

The American College of Physicians says it is not advocating for an extension of the ICD-10 deadline because CMS has addressed the organization’s concerns regarding end-to-end testing and physicians using clinical terminologies at the point of care.

“Unless the testing raises significant issues, then a delay would be unlikely to help,” ACP President Molly Cooke, MD, FACP, said in a written statement. “Additionally, it is important to note that many stakeholders, physicians included, have already invested significant resources in preparing for this change to occur on the currently scheduled timetable.”

 

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