A bill that delays Medicare payment cuts to physicians for another year contains two controversial and costly provisions that would delay both the implementation of the ICD-10 medical coding set and the so-called two-midnights rule.
The Senate Monday is expected today to take up a bill that would delay by one year a 24% cut in Medicare reimbursements for physicians mandated that otherwise takes effect on April 1 under the Sustainable Growth Rate funding formula.
The 121-page Protecting Access to Medicare Act of 2014 (H.R.4302) was rushed through the House in 25 seconds Thursday with no debate on an unrecorded voice vote, despite the strong objections of the American Medical Association, the American College of Surgeons, and other leading physicians' associations, which have been calling for a permanent fix.
House SGR Patch Bill Puts ICD-10, Two-Midnights Rule on Hold
Senate Majority Leader Harry Reid told The Hill that he would bring the bill to a vote Monday. "The patch that we have is imperfect, but it is something that will take care of things," Reid said. "I am disappointed we didn't get a permanent fix, but we should be very happy about what we have done."
Included in the bill, which was only made public last Wednesday afternoon, are two controversial provisions with great financial ramifications for providers. The compliance date for the ICD-10 medical coding set would be delayed to Oct. 1 2015 and the so-called two-midnights rule would be delayed until March 2015. The ICD-10 deadline has been extended once already.
The White House has not commented on the bill and whether or not President Obama would sign it or veto it. An official at the Centers for Medicare & Medicaid Services said the agency does not comment on pending legislation.
John Showalter, MD, Chief Health Information Officer at the University of Mississippi Medical Center in Jackson, expressed the frustration of many proponents of ICD-10 when he talked about the loss of credibility that would come with pushing back the implementation date until Oct. 1, 2015.
"I saw CMS had a really broad estimate of $1 billion to $6 billion in expense from delaying ICD-10. I think what's going to multiply that is the loss of engagement, so because CMS has been messaging so firmly," Showalter said in an interview Sunday.
"We've finally picked up the physician and coder engagement, so I now have all 17 of my department heads meeting with me monthly on how we're going to execute ICD-10, and if they delay it for a year, next year when I try to get those meetings, I won't get them, because they'll be waiting for Congress to delay again another year. They're going to think there's a pop-off valve. My biggest concern, although a billion dollars is a lot of money, is the provider and [engagement] that's been garnered in the last several weeks that's just going to go away."
If the Senate passes the bill and President Obama signs it into law, Showalter says physicians at the UM Medical Center will know who to blame. "I don't think they're going to blame us, but I think they're going to move into the thought process of once bitten, twice shy," he said.
"Now they're going to have been revved up and prepared for it twice, and they're really going to think it's never going to happen, and then when it does happen, it's going to be a big shock, and we're not going to be prepared for it because we're going to wait for that last-minute reprieve from now until eternity."
Additional reporting by Scott Mace.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.