Industry group accuses House of "trickery" in last-minute SGR temp fix

Despite industry opposition, the Senate may approve a temporary fix to the sustainable growth rate (SGR) formula on Monday in order to avoid a 24 percent physician pay cut that will take effect April 1 if legislators can't agree on a solution.

The bill, which passed the House of Represenatives in a quick voice vote Thursday, took the healthcare community by surprise, eliciting some harsh words from industry groups and healthcare leaders.

It offers a one-year delay to the SGR cuts, but it also postpones the implementation of ICD-10, the controversial "two-midnight rule" and recovery audits of medically unnecessary claims. 

The American Medical Association (AMA), which strongly opposes the temporary fix and urged its members to contact Congress to protest the action, expressed disappointment and accused House representatives of "trickery to pass an SGR patch that was opposed by physicians." 

"There was bipartisan, bicameral support for reform this year, yet too many in Congress lacked the courage and wherewithal to permanently fix Medicare to improve care for patients and provide greater certainty for physician practices," said Ardis Dee Hoven, M.D., president of the AMA in a statement. 

Senate Majority Leader Harry Reid (D-Nev.) worked personally with House Speaker John Boehner (R-Ohio) to come up with the latest bill, as they feared a bill approved by the House a few weeks ago, which offered a permanent repeal, wouldn't pass the Senate due to a last-minute insertion that tied it to a delay in the Affordable Care Act's mandate requiring all individuals to obtain health insurance.

The latest bill also falls short of a full repeal and instead offers a "patch" to the SGR, which the government has implemented only once since it introduced the formula in the late 1990s. Since then, Congress has authorized annual fixes in its place to prevent the payment cuts.

But the bill also delays the long-anticipated implementation of the ICD-10 coding system, which was supposed to take effect in a few months, to October 2015. It also postpones compliance with the two-midnight rule and recovery audits of medically unnecessary claims until March 2015.

These last-minute additions to the SGR bill took the industry--and lawmakers--by surprise, but easily passed the House in a voice vote Thursday that needed only a two-thirds majority. The bill only requires 60 Senate votes on Monday to move forward. The Senate vote, set for sometime after 2 p.m. EST., bumps up against Congress' self-imposed deadline to avoid the physician payment cuts that will take effect April 1 unless lawmakers take action against it.

Reid told The Hill that he would have preferred a permanent repeal of the SGR payment formula, which determines how much the government pays physicians who treat Medicare patients, but supports the temporary measure while lawmakers work on a long-lasting solution that includes agreement on how to pay for it. 

"The patch that we have is imperfect but it is something that will take care of things," Reid said, according to the publication. "I am disappointed we didn't get a permanent fix but we should be very happy about what we have done."

The timing of the Senate vote leads some to believe the SGR patch will pass even with all the last-minute additions. Jeff Smith, director of federal relations for the College of Healthcare Information Management Executives, told FierceHealthIT today that he's not optimistic that Senators will drop or truncate the ICD-10 language from the bill. 

"The prevailing chatter right now is that this was inserted as a way to appease some of the doc groups that are going to see a reduction in their reimbursement," Smith said. "I don't know that there exists enough political pressure behind the scenes to make this go away."

To learn more:
- read The Hill piece
- here's a link to the Senate floor schedule
- check out the AMA statement