Senate passes SGR bill, ICD-10 implementation date stands

HCPRO Website, April 15, 2015


By Melissa Varnavas
Late in the evening Tuesday, April 14, Congress passed the Medicare and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA), effectively ending the 17-year battle over cuts to physician reimbursement associated with the Sustainable Growth Rate (SGR).
The new law puts in place a merit-based incentive payment system (MIPS) that awards bonuses or imposes penalties based on physicians’ composite performance scores.
Passage of the bill prevented a 21% cut in Medicare payments to physicians that would have taken effect April 15. Instead, the bill will increase physician payments by 0.5% annually for the next four years, after which physicians will likely see annual payment increases of 0.25%.
American Medical Association (AMA) CEO James L. Madara, MD, praised the new bill in a press conference Wednesday. “This bill is a tremendous improvement over the competing and non-harmonizing payment methods, which, until yesterday, were current law,” he said. “As a nation we’re in the midst of a grand experiment. We’re rolling out measures for quality [and resolving the] problems and inhibitions [that] track back to the SGR.”
“The new legislation removes much of the instability and uncertainty that long has plagued the Medicare payment system so our practices can be here to serve our patients,” wrote AMA President Robert M. Wah, MD, in a letter to members Tuesday night. “A huge step in the right direction, the bill also includes several other important improvements for physician practices.”
In addition to addressing the SGR, the bill will extend the probe and educate audit period for the 2-midnight rule through September 30. Previously, the 2-midnight rule was limited to pre-payment reviews through March 30, unless auditors found evidence of systematic gaming, fraud, abuse, or delays in the provision of care. The bill implements the September date despite the fact that CMS extended the audits through the end of April while it waited for the Senate vote.
During the 2014 congressional battle over the SGR, a last-minute amendment delayed ICD-10-CM/PCS implementation from its then-current date of October 1, 2014. CMS subsequently moved implementation a year out to its present deadline of October 1, 2015. No delay language was included in this year’s SGR repeal.
“We’ve overcome an enormous hurdle here last night,” said Association for Clinical Documentation Improvement Specialists (ACDIS) Director Brian Murphy during an ACDIS Radio broadcast Wednesday. “It was certainly good news for physicians who have been struggling with the SGR and good news for us that there was no ICD-10 delay language included in the passage of the bill. Unless something completely new comes into play, I would suspect that we can move forward with the October 1, 2015 implementation date.”
CMS originally set the ICD-10-CM/PCS implementation deadline as 2011; subsequently, the agency pushed the deadline to 2013, then moved it again to 2014 after heavy lobbying from the AMA. Last year’s further delay to 2015 shocked many healthcare professionals, particularly those who had already invested in related staff training and technological enhancements.
The multiple implementation delays have negatively affected the healthcare industry’s preparations for the code set change, according to a February 2015 readiness survey from the Workgroup for Electronic Data Interchange (WEDI).
“With all the delays, I found that physicians turned off their listening modes in relation to ICD-10,” says Laurie L. Prescott, MSN, RN, CCDS, CDIP, Clinical Documentation Improvement (CDI) Education Specialist with HCPro, a division of BLR, in Danvers, Massachusetts. “So I changed my message. Instead, I focused not on the code set but on the quality of the documentation.”
Despite the SGR advancement, “we’re not out of the woods yet,” in terms of battling against ICD-10-CM/PCS implementation delays, warns founding ACDIS Advisory Board member Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-approved ICD-10-CM/PCS trainer.
A Tuesday AMA Wire article included the “costly transition” to ICD-10-CM/PCS as one of the “additional challenges physicians continue to face in the Medicare program,” Bryant notes.
 “Of course, the passage of this new bill is a good thing,” she says, “and the new plan has several components which will no doubt help our national healthcare system. And, of course, it was good there was no ICD-10 delay language included. But we need to continue to educate ourselves and our peers and advocate for implementation.”
Advocacy efforts supporting implementation may have helped keep additional delay language out of the SGR repeal bill, Bryant says, noting grassroots social media efforts and congressional outreach.
In fact, CMS itself has organized a CMS ICD-10 social media rally for Thursday, April 16, to encourage the healthcare community to show support for the ICD-10 transition.
The best preparation for ICD-10-CM/PCS may be to keep the coding conversation going, says Robert S. Gold, MD, founder of DCBA, Inc., in Atlanta, who also spoke during Wednesday’s ACDIS Radio program. “Help physicians understand what they need to be aware of within their own practice areas. Just getting them used to the verbiage now, today, will be the best thing we can do to help them prepare,” he says.