In a move that took over a decade to accomplish, the Senate voted 92-8 late Tuesday to repeal the sustainable growth rate (SGR) formula that adjusts Medicare payments to physicians.
The bill, H.R. 2, the Medicare Access and CHIP Reauthorization Act, did not include any references to ICD-10 implementation or an ICD-10 delay. The bill now moves to President Obama, who has indicated that he would sign the bill, according to a statement posted on the White House’s website.
The SGR repeal was seen by ICD-10 proponents as a major hurdle to overcome, who in 2014 saw a last minute ICD-10 delay slipped into SGR legislation that put off implementation of the new code set until October 1, 2015.
Though six amendments were voted on during the Senate debate, none of the amendments included language that would have impacted ICD-10.
Many physician groups have long detested the SRG formula, which linked Medicare payment increases to increases in the gross domestic product and typically threatened large payment cuts for physicians. The cuts were avoided by a series of 17 “patches” passed by Congress over the last 12 years in place of actual reform. The vote on Tuesday staved off a 21 percent reduction in Medicare payments to physicians, which would have gone into effect today.
The measure includes replacing the SGR with an increase of 0.5 percent in Medicare physician reimbursement starting in July 2015 through December 2015, and then annual 0.5 percent increases lasting through 2019, according to an article by MedPage Today.
The measure also consolidates various reporting programs, such as the “meaningful use” Electronic Health Record Incentive Program and several quality reporting programs, into a new merit-based incentive payment system and would incentivize physicians to participate in alternative payment models such as accountable care organizations (ACOs), according to MedPage Today.
The bill replaces physicians’ mandatory participation in the Value-Based Payment Program under Medicare with this new Merit-based Incentive Payment System (MIPS), according to an article in Healthcare Informatics. Under the new “MIPS,” which would start being applied to payments beginning Jan. 1, 2019, the Secretary of Health and Human Services would “assess appropriate adjustments to quality measures, resource use measures, and other measures used under the MIPS; and… assess and implement appropriate adjustments to payment adjustments, composite performance scores, scores for performance categories, or scores for measures or activities under the MIPS,” according to the bill.
A Healthcare Informatics analysis of H.R. 2 last month showed it targets four key areas: quality, resource use, clinical practice improvement (including care coordination and improvement activities), and the meaningful use program. The American Medical Association (AMA) said in a statement they feel this new streamlined system would “reduce the aggregate level of financial penalties physicians otherwise could have faced.”
The bill also extends the Children’s Health Insurance Program as well as funding for community health centers and the National Health Service Corps.
The AMA lauded Congress’ efforts to finally repeal the SGR and put in place a more sustainable payment system.
“Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians—facilitating the implementation of innovative care models that will improve care quality and lower costs,” said AMA executive vice president and CEO James L. Madara, MD, in a statement. “Patients will be able to get the care they need and deserve.”
In addition to addressing Medicare payment and creating the MIPS, the AMA reports that the legislation outlines several provisions that should be beneficial for physicians, including:
- Protections are included so that medical liability cases cannot use Medicare quality program standards and measures as a standard or duty of care.
- Incentive payments will be available for physicians who participate in alternative payment models and meet certain thresholds.
- Technical support will be provided to help smaller practices participate in alternative payment models or the new fee-for-service incentive program.
With the SGR repeal complete, ICD-10 proponents will now turn their attention to the upcoming series of appropriations bills about to make their way through Congress. AHIMA’s advocacy staff has identified the sometimes contentious appropriations process as the next place an ICD-10 implementation delay could be attempted.
The first of 12 appropriations bills will move to committee this week. Congress has until the end of the fiscal year, September 30, to pass the bills and fund various government programs and entities.
AHIMA’s Senior Director of Congressional Relations Margarita Valdez said AHIMA’s advocacy staff will monitor all of Congress’ activities, including the appropriations process, and work to ensure the ICD-10 implementation date remains October 1, 2015.