AGA Washington Insider

A policy blog for GIs

AGA Opposes House-Approved One Year SGR Patch, But Pleased About Potential Delay of ICD-10

The House approved H.R. 4302, legislation that would provide a one year freeze in Medicare physician payments and prevent the 24 percent cut from being implemented on April 1. The legislation, which is opposed by the AGA and almost the entire medical community, passed the House by voice vote and now heads to the Senate. The AGA opposes this temporary patch since it does nothing to fix the underlying problem with the Medicare physician payment system — it’s a temporary solution that finances the fix on the backs of specialty medicine.

The AGA is extremely disappointed that the House passed a patch since we were so close to finally enacting a permanent solution to the sustainable growth rate formula (SGR). This action not only jeopardizes a long-term solution, but also fractures unity in the physician community by picking winners and losers. Unfortunately, GI came out on the losing end of this, which will be bad for the millions of patients with digestive diseases.

However, AGA is pleased that the House has voted to temporarily delay the switch from ICD-9 to the ICD-10 coding system until Oct. 1, 2015. This legislation still needs approval in the Senate.

Why AGA Opposes It
The SGR patch legislation would finance the freeze by extending the misvalued codes initiative, under which CMS has the authority to identify and reevaluate misvalued codes. Gastroenterology has experienced this process: the three families of upper GI codes were resurveyed and subsequently cut by 12 percent. CMS failed to publish these changes until four weeks before they were to be implemented on Jan. 1. Colonoscopy has recently undergone this process and we will see changes to the reimbursement values of colonoscopy in the 2015 Medicare Physician Fee Schedule.

CMS has not been transparent in its process and continues to have unprecedented authority to make changes to codes that they deem overvalued and are specifically targeting specialty physicians. This provision will only make matters worse. At a time when the entire physician community came together to support a viable long-term solution to the SGR (S. 2000/H.R. 4015), this policy fractures that unity.

The Republican leadership was uncertain whether or not they would bring the bill to the floor for a vote since there was mounting opposition to the legislation. However, given the Senate’s inability to pass a long term SGR bill, the House leadership felt as though they needed to quickly bring a bill to vote that would prevent the 24 percent cut. In fact, the House leadership — both Republican and Democrats — brought the bill to the floor under suspension of the rules that requires a 2/3 vote. The majority of members were not even present for the vote and the leadership rushed the bill through for passage.

What Does This Mean for GI?
For some specialties like gastroenterology, this “freeze” amounts to a cut in payments when factored with the 2 percent across the board Medicare sequestration cut and recent CMS cuts to GI services. The misvalued codes provision, which basically “double downs” the administration’s existing authority, will put more pressure on the agency to find savings from codes that are high volume.

What Happened to the SGR Fix Legislation?
The new Senate Finance Chair Ron Wyden, D-OR, has been pushing legislation that was agreed to by all of the authorizing committees, both parties, both congressional chambers and the entire physician community that would repeal the SGR and transition physicians to a more value-based payment system. However, the major hurdle has been how to pay for a permanent fix. The House passed a permanent fix, but paid for it by delaying the individual mandate. Chairman Wyden proposes to pay for it by using the overseas contingency operations funds, which would have been used for the wars in Iraq and Afghanistan. Republicans oppose using these funds, which they call a gimmick. It is unsure whether the Senate will bring up Chairman Wyden’s proposal.


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