Physicians frustrated by SGR, ICD-10 delays

January 12th, 2015

Earlier this year, things were looking up for those seeking to repeal the Medicare sustainable growth rate and replace it with a quality-based formula that was more palatable for physicians. But last week, the effort to pass the overwhelmingly supported bill was killed when members of the House sneaked language into the bill that would delay the Affordable Care Act individual mandate for five years. And repeal efforts were dealt another blow yesterday when the House passed yet another “doc fix” patch bill, the 17^th of its kind. The patch is a one-year extension that will prevent a 24% cut in services to Medicare providers that was scheduled to take effect on April 1. While providers are certainly glad to see the big cut put on hold, some are still understandably frustrated over the continued delay in finding a permanent solution.

“By extending the Medicare provider sequester and 'cherry picking' a number of cost-savings provisions included in the bipartisan, bicameral framework, the [bill] actually undermines future passage of the permanent repeal framework,” American Medical Association president Dr. Ardis Dee Hoven said in a statement.

New Senate Finance Committee Chairman Ron Wyden is also opposed to the move, and is in favor of permanent SGR repeal with a new payment formula. However, the bill is not expected to fail in the Senate, as it was a bipartisan deal crafted by House Speaker John Boehner (R-Ohio) and Senate Majority Leader Harry Reid (D-Nev).

But the bill doesn’t just affect the doc fix issue – it also drew surprise by extending the deadline for ICD-10 implementation into 2015, and extends the controversial two-midnight rule recovery audit delay by six months, to March 31, 2015, rather than September 30 of this year.

Reaction to the ICD-10 coding implementation delays has also been negative, mostly from physicians who have worked hard to meet the October deadline. “Further delay of ICD-10 discredits the considerable investment made by stakeholders across the country to modernize healthcare delivery,” College of Healthcare Information Management Executives (CHIME) CEO Russell P. Branzell said in a statement. “Providers have already dedicated significant time and resources in financing, training and implementing the necessary changes to workflow and clinical documentation. Any disruption to the ICD-10 transition at this stage would be detrimental.” The American Health Information Management Association (AHIMA), which also opposes the ICD-10 delay, contends that it could cost the industry between $1 billion and $6.6 billion, in addition to what providers have already invested to prepare for the change.

The grumblings and opposition to the legislation are understandable. The bill with huge bipartisan and medical association support to replace the SGR was hijacked by partisan politics. Continued delays by a frustrating, divided Congress only add to the worry and stress physicians are feeling from having to prepare for new rules and regulations, not to mention the amount of money poured into making sure their hospitals and practices are prepared.