Disappointed societies see SGR vote as wasted opportunity

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 - Congress, House, Senate

The American College of Cardiology (ACC) said Congress squandered an opportunity to provide certainty over Medicare when it failed to permanently repeal the sustainable growth rate (SGR) formula.

Late on March 31, the Senate voted 64-35 to pass legislation that delays a 24 percent reduction in the Medicare physician payment, which was set to kick in on April 1. Senate Finance Committee Chairman Ron Wyden, D-Oregon, pressed the Senate for a permanent fix to the SGR, which had bipartisan support but got hung up over funding issues.

The House extended the patch last week. President Obama is expected to sign the bill into law.

The ACC said that the legislation includes provisions that it had pushed for in the full repeal of the SGR but characterized lawmakers’ inability to finally put an end to the SGR as a wasted opportunity.

The provisions provide a 0.5 percent payment update through 2014 and no update from Jan. 1, 2015 through March 31, 2015; delay implementation of ICD-10 for a year; extend the review of the two-midnight rule for the first half of 2015; incorporate appropriate use criteria and clinical decision support into advanced diagnostic imaging; allow revised payment for potentially misvalued codes in the physician fee schedule; require CT equipment to adhere to certain dose standards by the beginning of 2016; and other mandates.  

Other medical organizations also expressed disappointment in the extension of the patch. The American Medical Association (AMA) claimed that to date the temporary patches have cost more than a permanent solution would have. This is the 17th patch on the SGR.

"This bill perpetuates an environment of uncertainty for physicians, making it harder for them to implement new innovative systems to better coordinate care and improve quality of care for patients,” AMA President Ardis Dee Hoven, MD, said in a statement.

Lynne Thomas Gordon, MBA, CEO, of the American Health Information Management Association (AHIMA), said the association will seek clarification on the ICD-10 delay. “AHIMA will continue our work with various public sector organizations and agencies such as the Centers for Medicare & Medicaid Services (CMS), the Office of the National Coordinator for Health IT, and the National Center for Health Statistics (NCHS) along with our industry partners such as the ICD-10 Coalition so that ICD-10 will realize its full potential to improve patient care and reduce costs,” Gordon said.