All aboard the last train, see you next year on Medi­care SGR

Modern Healthcare - - LATE NEWS - —Paul Demko

Congress ap­pears poised to pass yet an­other patch to Medi­care’s un­pop­u­lar sus­tain­able growth-rate for­mula for physi­cian pay­ments de­spite fer­vent op­po­si­tion from the Amer­i­can Med­i­cal As­so­ci­a­tion, its al­lies and oth­ers.

That would set up an­other SGR cri­sis next year, frus­trat­ing physi­cian groups that felt closer than ever to per­ma­nently re­solv­ing the prob­lem.

Mon­day af­ter­noon, the Se­nate is ex­pected to con­sider the 12-month patch, which the House ap­proved Thurs­day. Op­po­nents seek­ing per­ma­nent re­peal lob­bied over the weekend to rally op­po­si­tion. But Hill watch­ers as­sume sen­a­tors, even those op­posed to a tem­po­rary patch, will pass the mea­sure rather than face the quag­mire of how to pay for a per­ma­nent fix.

The one-year patch sur­faced at the eleventh hour af­ter leg­is­la­tors failed to reach agree­ment on pay­ing for physi­cian pay­ment re­form, at a cost of at least $138 bil­lion over a decade. With­out a new patch or a per­ma­nent so­lu­tion, doc­tors face a po­ten­tial 24% cut in Medi­care pay­ments April 1. The patch would be paid for through a budget gim­mick ex­tend­ing Medi­care se­quester cuts be­yond the 10-year win­dow used for budget scor­ing pur­poses and through cod­ing changes low­er­ing physi­cian pay­ments.

The deal was cob­bled to­gether by House Speaker John Boehner (R-Ohio) and Se­nate Ma­jor­ity Leader Harry Reid (D-Nev.) to the cha­grin of many of their own cau­cus mem­bers. It emerged as part of a Christ­mas tree bill with a va­ri­ety of ma­jor, un­re­lated health­care pro­vi­sions that pleased some and an­gered oth­ers. Win­ners seemed to be hos­pi­tals in non-Med­i­caid ex­pan­sion states and health­care or­ga­ni­za­tions that weren’t ready to im­ple­ment the com­plex new ICD-10 cod­ing sys­tem on Oct. 1.

Pro­vi­sions in the bill in­clude a six-month par­tial en­force­ment de­lay for the con­tro­ver­sial two-mid­night pay­ment rule for hos­pi­tals, and a one-year de­lay in Med­i­caid cuts to hos­pi­tals that serve a dis­pro­por­tion­ate num­ber of poor people. That was wel­come news for hos­pi­tals in states that haven’t ex­panded Med­i­caid. The bill also post­poned im­ple­men­ta­tion of ICD-10 cod­ing for at least a year past its sched­uled Oct. 1 start. The de­lay in what could be a rocky tran­si­tion to the new cod­ing sys­tem may turn out to be a break for Democrats run­ning for elec­tion in Novem­ber.

“This is likely to be the last train out of town on Medi­care changes for a while,” said Chip Kahn, pres­i­dent and CEO of the Fed­er­a­tion of Amer­i­can Hos­pi­tals. “That’s why this was a train that had a lot of cars be­tween the en­gine and the ca­boose.”

With op­po­si­tion sur­fac­ing among House Repub­li­cans, GOP lead­ers rushed the bill through on a voice vote with no roll call, when few mem­bers were on the floor. That gam­bit left mem­bers be­wil­dered or irate, but it moved the bill on to the Se­nate.

Then at­ten­tion turned to new Se­nate Fi­nance Chair­man Ron Wy­den (D-Ore.), who blasted the tem­po­rary SGR patch and was ex­pected to bring forth his own pro­posal for a per­ma­nent fix, likely paid for with Over­seas Con­tin­gency Op­er­a­tions funds. But with lit­tle chance of that fund­ing op­tion re­ceiv­ing House GOP sup­port, ob­servers ex­pected Wy­den to bow to the in­evitabil­ity of an­other SGR patch.

“It’s kind of like the stages of grief,” said Dean Rosen, a part­ner at the lob­by­ing firm of Mehlman Vo­gel Castag­netti and a for­mer top GOP staffer on health­care is­sues. “You have to go through them to get to the end.”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.