Congress, President Defer Painful Actions

Abstract

Whether election year ennui was the cause or not, Congress and the President started 2012 by putting off major actions that would affect health care professionals. One event pleased physicians, but the other, while rescuing doctors from an immediate and drastic pay cut, continued years of frustration rooted in the Sustainable Growth Rate formula for Medicare payments. First, the Health and Human Services department announced Feb. 16 that it would not for the foreseeable future implement ICD-10 codes, formally known as the International Classification of Diseases, 10th Edition, diagnosis and procedure codes. Physician organizations had sought just such a delay, stating that it would be unduly burdensome to switch to the new system at a time when clinicians were also adjusting to information technology requirements under the Affordable Care Act. The ICD-10 had been scheduled to go into effect on Oct. 1, 2013. No new compliance date was announced. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” HHS Secretary Kathleen Sebelius said in a statement. The American Medical Association was among the most vocal in seeking a delay. The new system would have an estimated 68,000 codes, replacing the 13,000 codes contained in the current system (ICD-9), according to the AMA. In January, the AMA wrote to House Speaker John Boehner (R-Ohio) asking him to find a way to stop implementation of ICD-10. Physicians could face implementation costs anywhere from $83,290 to more than $2.7 million, depending on the size of the practice, according to the letter. Six days after the ICD-10 announcement, President Obama made it official that physicians will not face Medicare payment cuts this year, when he signed a compromise reached by members of Congress that included an extension of both the payroll tax holiday and unemployment benefits. The bill averted the 27% pay cut that was scheduled to take effect on March 1, as called for under the Sustainable Growth Rate formula (SGR). But if Congress and the President don’t act again this year, doctors could see their Medicare payments cut by nearly a third come Jan. 1, 2013. Physician organizations reacted to the news with a mixture of relief and disappointment. The American College of Physicians, the American Academy of Family Physicians, the American College of Surgeons, and the American Osteopathic Association, chastised Congress for failing to use savings from slowing the wars in Iraq and Afghanistan to finance a permanent repeal of the SGR. The legislation is funded at the expense of several categories of health care providers, including skilled nursing facilities. To pay for the SGR fix and other provisions of H.R. 3630, Congress reduced the amount that Medicare will pay hospitals, skilled nursing facilities, and certain health clinics to cover bad debts from beneficiaries’ unpaid co insurance and deductibles. Payments to clinical laboratories were cut by 2%, and the lawmakers stripped $5 billion from the Prevention and Public Health Fund, an Affordable Care Act program that funds preventive health programs. The reductions are slated to start in October (fiscal year 2013). CfA