John Commins | March 28, 2014
The Senate must take up the bill by Monday, the day the SGR deadline expires, to avoid the mandatory and perennially delayed cuts to Medicare payments to physicians. The bill, which passed the House Thursday, includes two controversial provisions.
The U.S. Senate is about to take up potentially the most sweeping piece of healthcare legislation since the passage of Obamacare. The Senate is expected to vote Monday on a stop-gap measure that will place year-long delays on three critical, contentious, and costly federal mandates affecting a wide swath of providers and vendors.
The House passed the measure Thursday.
The Protecting Access to Medicare Act of 2014 (H.R.4302) would temporarily delay for the 17th time reimbursement cuts to the Medicare Sustainable Growth Rate funding formula that are scheduled to take effect on April 1.
Stuck inside the 121-page bill, which emerged for public view on Wednesday, are two other controversial and costly provisions to delay by one year both the implementation of the ICD-10 medical coding set and the so-called two-midnights rule. With little fanfare and no speeches, H.R.4302 passed the House on Thursday during a hastily convened voice vote, with no debate and no record of how votes were cast.
The Senate must take up the bill by Monday, March 31, the day the SGR deadline expires, to avoid the mandatory and perennially delayed cuts to physician reimbursements, which have grown over the decade to represent a 24% reduction in Medicare payments to physicians.
It’s not clear how the bill will fare in the Senate. Calls Thursday to the media office of Senate Majority Leader Harry Reid, (D-NV), were not returned. House Speaker John Boehner, (R-OH), said at a media availability on Wednesday that Reid had agreed on the bill.
So far, the bill has drawn no public response or veto threats from the White House or comments from the Department of Health and Human Services. Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner has repeatedly and firmly said that the Oct. 1, 2014 start-up date for ICD-10 will be met. CMS officials said Thursday that they do not comment on pending legislation.
The House vote for a temporary fix for the reviled SGR came as no surprise. It became apparent earlier this month that another Band-Aid would be applied to the SGR when House Republicans insisted that plugging the then-estimated $122 billion cost of a permanent fix be paid for by delaying for five years the implementation of the individual mandate under the Patient Protection and Affordable Care Act. Senate Democrats rejected the proposal and everyone braced for another last-minute fix.
The American Medical Association has for months been calling for a delay and even a rescinding of ICD-10 implementation, but even the inclusion of a one-year delay on the mandate until Oct. 1, 2015 did not mollify AMA President Ardis Dee Hoven, MD, who had made a full repeal of the SGR the association’s top priority.
“The American Medical Association is extremely disappointed in (Thursday’s) House action to give up on SGR repeal,” Hoven said in prepared remarks. “There was bipartisan, bicameral support for reform this year, yet too many in Congress lacked the courage and wherewithal to permanently fix Medicare to improve care for patients and provide greater certainty for physician practices. Congressional leadership had to resort to trickery to pass an SGR patch that was opposed by physicians.”
ICD-10
Even though the stop-gap fix for SGR was widely expected, the 11th hour inclusion of the delays to the two-midnights rule and ICD-10 stunned even seasoned Congress-watchers.
“They had been working on this total reform package of SGR for over a year with a lot of parties from the physician community and then this blows up at the last minute,” said Sharon F. Canner, Senior Director of Public Policy at the College of Healthcare Information Management Executives. “I heard the press accounts about rural hospitals that weren’t ready. Well, it’s never going to be perfect. Perfect is the enemy of the good. The cost of this is enormous in terms of systems that hospitals have ordered and trained staff.”
Canner says the ICD-10 delay was put in the bill as a sop to specialty physicians’ groups who were angry because Congress had squandered another opportunity to find a permanent fix for the SGR. “It was something they were unhappy with and so they came to the leadership and asked them to pull this,” Canner says.
“The leadership said ‘no we can’t do this. There is money attached, but is there something else that you want?’ and they wanted a delay in ICD-10. Meanwhile, the AMA which has been strongly pushing for a delay on ICD-10 decided that they did not want this SGR patch. They said there has been a lot of good bicameral bipartisan work done to finally get rid of this SGR so that we don’t have to come back every year with the same fire drill. AMA is on our side for a little while, but we don’t know for how long.”
The ICD-10 deadline had already been pushed back one year to 2014, and CMS has estimated that the cost of delaying it another year could range from $1 billion to $6 billion.
Two-Midnights Rule, and RAC
The provision to delay implementation of the two-midnights rule until March 31, 2015 was greeted with cheers at the American Hospital Association, which made no bones about its lobbying efforts on H.R.4302. “The AHA worked to ensure that there would be relief on the two midnight policy and we are pleased it was included in the bill,” the association said in response to a query
However, the provision left a government watchdog group howling. The Council for Citizens against Government Waste says CMS had already suspended recovery audit contractor post-payment reviews for the past six months. A year-long extension of the suspension provided in H.R.4302 means that the RAC program would be on hiatus for 18 months, costing taxpayers billions of dollars in undetected overcharges to hospitals and other providers.
“The inclusion of the RAC suspension language is ironic given that the CMS finally released its overdue FY 2012 Annual Recovery Audit Contractor Report to Congress, which documents the RACs’ monumental record of success in recovering billions in improper payments,” CCGW said in a media release. “Auditors recovered $2.3 billion in erroneous Medicare payments in FY 2012, up from $797.4 million in FY 2011, and the contractors had accuracy scores of between 92% and 97%.”
CCGW noted that the RAC program has “clawed back” more than $7 billion in improper payments since 2009. The watchdog group cited a Department of Health and Human Services report last December showing that since CMS began meddling with the RAC program, improper payments in Medicare rose by 12.7%, from $44.3 billion in FY 2012 to $49.9 billion in FY 2013.
‘Really Bad Governance’
“This must-pass patch that has to be done once every whenever is another opportunity for bad language to be grafted onto this must-pass bill at the 11th hour, which is exactly what we saw today,” says Leslie K. Paige, vice president, policy & communication at CCGW. “It is really bad governance. I can’t say it any other way. It doesn’t matter if it is Republicans or Democrats. This is dysfunctional government at its worst and we saw it today.”
“They ended up doing a voice vote, which is the least accountable way to pass a very significant piece of legislation which had a lot of moving parts and a lot of other provisions included in it which no one fully understands what the implications are and the costs associated with them. But once again a lot of members of Congress crowded around a bill they know they had to pass and they’re sticking a lot of stuff into it and then they have the temerity to take a voice vote on it a few days before the deadline arrives. It’s insane.”
Source: Health Leaders Media
http://www.healthleadersmedia.com/page-1/HEP-302343/House-SGR-Patch-Bill-Puts-ICD10-TwoMidnights-Rule-on-Hold