Tem­po­rary SGR fix frus­trates many

Modern Healthcare - - NEWS - By Cather­ine Hol­lan­der

Spurring anger among physi­cians, Pres­i­dent Barack Obama signed a bill last week pre­vent­ing steep cuts to Medi­care physi­cian pay­ments for one year af­ter Congress failed to agree on a way to pay for per­ma­nent physi­cian pay­ment re­form. Adding to providers’ dis­may, the bill also de­layed the con­ver­sion to ICD-10 cod­ing for at least a year. The new law also would par­tially de­lay en­force­ment of a con­tro­ver­sial in­pa­tient pay­ment rule for hos­pi­tals, the “two-mid­nights rule,” for six months.

The Se­nate voted 64-35 in fa­vor of the Pro­tect­ing Ac­cess to Medi­care Act of 2014, which the House ap­proved the week be­fore. It will be the 17th tem­po­rary patch Congress has en­acted since the Medi­care sus­tain­able growth-rate for­mula be­came law in 1997.

Sen. Tom Coburn (R-Okla.) said the bill was an ex­am­ple of “why the Amer­i­can people are disgusted with (Congress)… We should be fix­ing this prob­lem, in­stead of de­lay­ing the prob­lem.”

The new law will freeze Medi­care physi­cian pay­ments only through March 2015. Se­nate Ma­jor­ity Leader Harry Reid (D-Nev.) said the leg­is­la­tion was “not ideal,” but that he lacked the votes for a per­ma­nent so­lu­tion. With­out the patch, physi­cian pay­ments would have been cut by 24% as of last Tues­day.

Dr. Ardis Dee Hoven, pres­i­dent of the Amer­i­can Med­i­cal As­so­ci­a­tion, said her or­ga­ni­za­tion was “deeply dis­ap­pointed” with the patch. “This bill per­pet­u­ates an en­vi­ron­ment of un­cer­tainty for physi­cians,” Hoven said.

Hopes were high that Congress would pass a per­ma­nent so­lu­tion this year. In Fe­bru­ary, the House En­ergy and Com­merce and Ways and Means com­mit­tees and the Se­nate Fi­nance Com­mit- tee re­leased a bi­par­ti­san pro­posal for re­form­ing the SGR for­mula, but could not agree on how to pay for it.

Sen. Ron Wy­den (D-Ore.), chair­man of the Se­nate Fi­nance Com­mit­tee, asked the Se­nate to con­sider a unan­i­mous con­sent to pass a per­ma­nent re­place­ment for the SGR, to be funded by sav­ings from wind­ing down the war in Afghanistan.

Sen. Jeff Ses­sions (R-Ala.) ob­jected, then put for­ward his own pro­posed so­lu­tion of re­peal­ing the Af­ford­able Care Act’s man­date for in­di­vid­ual health in­sur­ance, which would off­set the cost of find­ing a per­ma­nent so­lu­tion to the SGR.

Still, talk of a per­ma­nent fix hasn’t stopped. “We’re far­ther down the road than we’ve ever been be­fore,” said Julius Hob­son, a se­nior pol­icy ad­viser at law firm Polsinelli, who closely fol­lows SGR ne­go­ti­a­tions.

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