Senate Approves SGR, ICD-10 Extensions

Published on: 

In a 64-35 vote, the Senate approved the seventeenth fix to the sustainable growth rate (SGR) payment formula.

In a 64-35 vote, the Senate approved the seventeenth fix to the sustainable growth rate (SGR) payment formula. The decision came only days after the House of Representatives voted in favor of the same “doc fix” bill, which will also delay the mandated implementation of International Classification of Diseases, Tenth Revision (ICD-10) coding and the 2-midnight rule within hospitals for another year.

“I’m pleased that we’ve been able to come to an agreement to vote today on a 12-month fix to the Medicare physician payment system. We need to take action on this to ensure that Medicare patients will be able to see their doctors,” Senate Majority Leader Harry Reid said Monday in a speech on the Senate floor. “But the fact remains that the agreement we have in place is not ideal… regrettably, we just don’t have the votes right now to fix this problem for good.”

Industry experts predicted the bill would pass through the Senate, despite opposition from many physician groups. Physician group representatives said they would be willing to accept a 24% cut in Medicare reimbursement payments if it would result in a permanent repeal of the highly contested SGR formula. Taking the payment cuts would force some practices to refuse Medicare patients and, in turn, force Congress to decide on how to pay for the SGR repeal. However, that proposition went unanswered. A permanent repeal could cost as much as $180 billion, yet no one is willing to shoulder the costs.

“We have never opposed a patch before,” said American College of Physicians spokesman David Kinsman. “This is unique because we’re so close. This time, we have bicameral and bipartisan support for permanent reform.”


Senator Reid explained that an inability to arrive at an agreeable permanent SGR fix resulted in the decision. “I hope it’s our last patch,” he said.

Grouping other policy measures, such as ICD-10 and the 2-midnight rule, has also raised concerns.

“We’re generally not pleased that something as critical as ICD-10 becomes fodder for other legislation,” said Russell P. Branzell, FCHIME, CHCIO, president and CEO of the College of Healthcare Information Management Executives. “That’s an area that needs to either stand on its own and/or be discussed on its own. When you start combining all these programs together, none of them can be looked at on their own merits and concerns.”

Established in 1997, the SGR system has determined how much physicians are paid in relation to the projected growth of the economy. Since 2003, Congress has passed yearly “doc fox” bills as a way to compensate doctors’ Medicare reimbursements as healthcare costs continually rise.

Around the Web

Senate OKs SGR patch, delays ICD-10 [Fierce Healthcare]

Docs Would Accept Payment Cuts to Force Permanent SGR Repeal [Fierce Healthcare]

Senate Delays ICD-10, Patches SGR [Healthcare Payer News]

For 17th Time in 11 Years, Congress Delays Medicare Reimbursement Cuts as Senate Passes ‘Doc Fix’ [The Washington Post]