D'Arcy Gue

SGR Fix Is Moving Ahead, and So Is ICD-10

March 31, 2015

Healthcare Industry, ICD-10 2 Minute Read

For over a decade, one of the few things Republicans and Democrats have always agreed on was that the sustainable growth rate (SGR), an attempt to limit the rise in physician reimbursements (introduced in the Balanced Budget Act of 1997), was a failure. Over the last decade, Congress has made at least 10 adjustments to the SGR formula to prevent significant cuts in reimbursements, which in recent years would have exceeded 20%. More than once, Congress has set out to enact a permanent fix for SGR, only to end up with a temporary “patch” to delay the cuts.  Last year’s patch also delayed ICD-10 — but this year looks very different.

Last year,  Congress “kicked the can down the road” again, unable to agree on a permanent SGR fix, even though it had led major physicians groups to expect one. The patch Congress agreed on instead, the Protecting Access to Medicare Act of 2014, had an additional bit of language, apparently intended to mollify physicians.  The extra language succeeded in doing that — but it also changed the landscape for the entire healthcare industry, by imposing an additional year’s delay of the implementation of ICD-10.

This month, when the SGR issue came up again, there was hope by some healthcare providers that Congress would include yet another ICD-10 delay in its legislation.   No such luck. Last Thursday the House passed a full repeal of SGR, entitled the SGR Repeal and Medicare Provider Payment Modernization Act of 2015, by an overwhelming 392-37 margin — with no ICD-10 language to be seen.

The Senate is expected to take it up immediately when it reconvenes on April 13,  after its Easter Break adjournment.  Large bipartisan support indicates there’s no reason to expect any hurdles.  In order to avoid Medicare cuts, the measure will need to be passed immediately, so there is every reason to do so quickly.

According to Reuters, Senate Majority Leader Mitch McConnell said “We’ll turn to it very quickly when we get back. I think there’s every reason to believe it’s going to pass the Senate by a very large majority.” President Obama already has indicated he will sign the legislation.

What does this mean for ICD-10? ICD-10 is going to happen this year, so providers had better be ready!

To learn more, or get help, contact us.

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