SGR ‘doc fix’ bill could delay ICD-10 by a year

A bill has been reportedly negotiated by U.S. House and Senate leaders that would not only extend the Sustainable Growth Rate (SGR) “doc fix” and provide a 12-month delay to the March 31, 2014 expiration date, but would also delay the ICD-10 compliance date by another year.

The ICD-10 provision, seven lines in total, was tucked away in the bill in Sec. 212. The bill is up for a vote on Thursday (March 27, 2014) of this week. If passed, it says the Department of Health and Human Services (HHS) cannot adopt ICD-10 as its standard code-set prior to Oct. 1, 2015. The current compliance date has been set for Oct. 1, 2014 of this year. Organizations like the American Health Information Management Association are calling for a removal of the ICD-10 delay provision.

However, on Feb. 27, during the HIMSS Conference in Orlando, Florida, Centers for Medicare and Medicaid Services administrator Marilyn Tavenner, R.N., asserted firmly that CMS and HHS would not consider any further delays in the ICD-10 transition beyond Oct. 1 of this year.

The SGR, which is the formula for physician payment established under Medicare since 1997, has been repeatedly “fixed” in order to avert physician payment cuts under Medicare. The formula attempts to control growth in Medicare spending on physician fees by tying reimbursement to economic growth. Unfortunately, because of the yearly “fixes” since 1997, the amount the federal government in effect owes itself has grown to somewhere between $150 billion and $250 billion, a staggering sum that, legally, must be resolved. On March 31, the current formula is set to reduce Medicare physician payments by a significant amount–depending on estimates, approximately 30 percent in the coming fiscal year.

Leaders in Congress and physician stakeholders alike say the formula is unsustainable, and both political parties have been trying to figure out how to repeal and replace it permanently. Physicians, according to a recent poll by the American College of Physician Executives (ACPE), do not want the SGR repeal to be tied to a delay in the individual mandate under the Affordable Care Act.

Several media outlets are reporting that the bill was reportedly negotiated by House Speaker John Boehner (R-Ohio) and Senate Leader Harry Reid (D-Nevada). According to media reports from Modern Healthcare, Boehner said in a press conference that this was only a temporary solution and they were working on a long-term fix to the SGR.

Topics: Accountable Care Organizations (ACOs) , Medicare/Medicaid , Regulatory Compliance