House approves temporary SGR fix

The House of Representatives on Thursday approved a temporary fix to the sustainable growth rate (SGR) for one year in a bill that also delays ICD-10 implementation until at least October 2015 and postpones hospital compliance with the controversial "two-midnight rule"and recovery audits of medically unnecessary claims until March 2015.

UPDATE: Senate approves temporary SGR fix

The last-minute voice vote, arranged under special rules that provided for no amendments and limited debate, needed only a two-thirds majority (290) vote.

The bill still needs approval of the Senate before Congress' deadline of midnight on Monday, March 31.

The House, a few weeks ago, approved a bipartisan permanent fix to the much-hated SGR formula and replaced it with one that offers incentives to physicians who provide high-quality, low-cost care. However, the Senate has yet to pass that bill and since then lawmakers inserted measures in the bill tying it to a delay in the Affordable Care Act's mandate requiring all individuals to obtain health insurance.

A majority of physician leaders opposed linking the repeal of the SGR to a delay of the individual mandate, according to a poll from the American College of Physician Executives. 

The latest bill, once again, provides a short-term fix to the SGR payment formula, protecting physicians from 24 percent pay cuts for one year due to take effect April 1. Since the government introduced the formula in the late 1990s, it has only been deployed a single year, with Congress authorizing annual "fixes" in its place to prevent a cut to physician Medicare payments.

But in a move that came as a surprise to many in the healthcare industry, late Tuesday night lawmakers pitched the new bill that provides the SGR patch but also lumped in a delay to ICD-10, the two-midnight rule and recovery audits of medically unnecessary claims through March 31, 2015. House Speaker John Boehner and Senate Majority Leader Harry Reid negotiated the last-minute fix.

Boehner told Politico that he was confident that he could get GOP support for the short-term patch, but also needed dozens of Democrats to back it as well.

But many in the healthcare industry oppose the latest bill. The American Medical Association urged its members to contact their representatives and tell them to vote no on temporary fixes.

And the Council for Citizens Against Government Waste (CCAGW) and the National Taxpayers Union  said in a statement that the legislation would "nullify the Centers for Medicare and Medicaid Service's Recovery Auditing Contractors program by delaying implementation of the two-midnight rule and, more alarmingly, suspending recovery audits of medically unnecessary and improper healthcare claims through March 31st, 2015."

The action is "ironic," the statement said, given a CMS report documenting the success RACs had in recovering billions in improper payments.

Still, Boehner stands by his proposal, telling Reuters, it "does not preclude any work from being done on the long term fix in terms of how we pay doctors. I frankly think the permanent fix that's being talked about is a good fix, What there isn't agreement on, is how are we going to pay for it."

The cost of a permanent repeal is now estimated at more than $180 billion, according to the latest Congressional Budget Office report.

House Minority Leader Nancy Pelosi (D-Calif.) said she prefers a permanent solution but would support the "Band-Aid" legislation so seniors on Medicare don't have to pay the bigger price.

Rep. Joe Pitts (R-Pa.) agreed, stating, "A vote 'no' today is a vote against seniors. We are not voting for the AMA today."

To learn more:
- here's the bill (.pdf)
- read the Politico article
- here's the AMA statement
- check out the CCAGW and NTU statement
- here's the Reuters article