SGR patch, ICD-10 delay passes House in a voice vote

March 27, 2014

Despite staunch opposition from physician advocates, the bill, which was introduced on Wednesday, will move to the Senate in an effort to pass the legislation before the current SGR fix expires on March 31.

The House approved today a one-year patch to the sustainable growth rate (SGR) and a delay to the implementation to the International Classification of Diseases-10th Revision (ICD-10) until October 2015. Despite staunch opposition from physician advocates, the bill, which was introduced on Wednesday, will move to the Senate in an effort to pass the legislation before the current SGR fix expires on March 31.
 
The measure passed using a voice vote, which The Hill says, “appears to have been a way to avoid a potentially failed vote on a bill that both GOP and Democratic leaders said must pass.” 

If Congress is unable to reach an agreement before April 1, physicians will see a 24% reduction in Medicare payments. The latest 121-page bill being negotiated would extend the fix until March 2015. If passed, this will be 17th patch to the SGR.  
 
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.

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.

Although the bill would delay ICD-10, the AMA says it opposes any temporary fix to SGR and continues to call for its repeal.

“By extending the Medicare provider sequester and ‘cherry picking’ a number of cost savings provisions included in the bipartisan, bicameral framework, the ‘Protecting Access to Medicare Act’ actually undermines future passage of the permanent repeal framework,” AMA President Ardis Dee Hoven, MD, said in a written statement. “Further, it would perpetuate the program instability that now impedes the development and adoption of health care delivery and payment innovation that can improve health care and strengthen the Medicare program.”

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 of the American College of Physicians, said the college favors the ICD-10 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."

Reid Blackwelder, MD, FAAP, president of the American Academy of Family Physicians, says that he hoped for a permanent repeal of the SGR formula, which has cost more than $160 billion in the last decade. “After months of painstaking work, Congress is moving away from, rather than toward the goal. Congress’s continuing failure to repeal the SGR perpetually threatens access to Medicare services for millions of elderly and disabled Americans and continues the cycle of expensive, temporary delays in reform to Medicare physician payment,” Blackwelder says.
 
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.