Call it political Münchausen syndrome by proxy.
Molly Cooke, M.D., FACP, president of the American College of Physicians (ACP) said Congress was holding healthcare for seniors, military families, and disabled persons on Medicare and TriCare “hostage.”
For the seventeenth time in 11 years, Congress has acted at the last minute to save the patient made sick by their own required 24% cuts to Medicare payments to physicians called for by the Medicare Sustainable Growth Rate (SGR) funding formula. This time the temporary cure includes year-long delays to the cuts, the implementation of the ICD-10 medical coding set and the so-called 2-midnights rule. The new law also includes an 18-month hiatus for RACs (Recovery Audit Programs).
Physicians will see a 0.5% increase in payments during the next year.
The hostages will now be held until April Fool’s Day in 2015. Ironic.
Physicians Upset
Physicians are particularly upset this time because an affordable permanent fix had been agreed to by a bipartisan group of congressional leaders. With midterm elections at hand and the next presidential campaign on the horizon, neither political party will have any incentive to act boldly on any issue.
The American Medical Association’s President Ardis Dee Hoven, M.D., said the association, “is deeply disappointed by the Senate’s decision to enact a 17th patch to fix the flawed formula. Congress has spent more taxpayer money on temporary patches than it would cost to solve the problem for good.”
AdvaMed Applauds
While physicians were upset, AdvaMedDx, a division of AdvaMed, the device industry trade association, was downright giddy, applauding the legislation because it included diagnostic payment reforms.
The House took a voice vote on the bill on Thursday, with no debate and no record of how votes were cast. The Senate, over the objections of most physician organizations, passed the bill on March 31, 2014. The Senate voted 64-35 to delay the cuts. Fifteen Republicans voted with Democrats in favor of the delay while six Democrats voted against it.
None of this came as a surprise as Republican support in the House for SGR repeal began to crumble over where the $122 billion to pay for the fix would come from. They insisted Democrats in the Senate and President Obama delay implementation of Obamacare for five years and use those funds to pay physicians.
ICD-10 Delay
Sharon F. Canner, senior director of Public Policy at the College of Healthcare Information Management Executives said the ICD-10 delay was put in the bill as a sop to specialty physicians’ groups who were upset that the chance for a permanent fix had been wasted. “It was something they were unhappy with and so they came to the leadership and asked them to pull this, ” Canner says.
The ICD-10 deadline had already been pushed back one year to 2014, and CMS (Centers of Medicare and Medicaid Services) has estimated that the cost of delaying it another year could range from $1 billion to $6 billion.
Hospitals Cheer, Watchdogs Howl
The hospitals cheered the delay of the 2-midnights rule until March 31, 2015.
The suspension of the RAC program was criticized by the taxpayer watchdog organization, the Council for Citizens Against Government Waste. The council said CMS had already suspended recovery audit contractor post-payment reviews for the past six months. A year-long extension of the suspension of the program would cost taxpayers billions of dollars in undetected overcharges to hospitals and other providers.
According to CMS, spending on Medicare totaled about $580 billion in 2012 for 49 million beneficiaries. Spending is projected to reach $1.123 trillion in 2022.
