When the guffaws subside, ask yourself: Does this really cost hospitals money? The bill's drafters knew better. The final paragraph of the 123-page bill states “the budgetary effects of this Act shall not be entered on any PAYGO (Pay As You Go Act of 2010) scorecard.”
Let's move on to the ornaments on the tree (in Easter season no less). Since sequester cuts stayed in place, Congress hoped to dampen opposition from provider groups by including a one-year postponement in disproportionate-share payment cuts that were included in the Patient Protection and Affordable Care Act to help pay for subsidies for the newly insured. Hospitals that treat excess numbers of poor and uninsured patients have traditionally relied on DSH payments to make ends meet.
The move to suspend the DSH cuts will be especially welcomed in states that refused to expand Medicaid to cover people up to 138% of the poverty level. Prior to this doc-fix bill, those states' providers were hit with a double whammy—not only were their DSH payments cut, but they didn't get the extra revenue (all of it from the federal government) for their previously non-paying poor patients. It was one of their main talking points in fighting for Medicaid expansion.
With the ACA stick gone—at least for another year—hospitals in non-expanding states will have a far more difficult time convincing their legislators and governors that they face dire economic peril by foregoing additional Medicaid money. They will, of course, get the DSH money.
Another major goody in the bill was Congress' decision to postpone for another year the conversion to ICD-10 coding for hospital and physician office billing. But who benefits from this present? Surely it's not the 36% of respondents to Modern Healthcare's most recent Information Technology Survey who said they were “highly confident” they could be fully compliant with ICD-10 by Oct. 1, 2014, or the 41% of respondents who opposed any further delay in implementation. These are the provider institutions and offices that have spent tens of millions of dollars and countless hours preparing for a smooth transition.
Hospital bean counters faced with declining admissions and eroding margins are already looking at IT budgets as one place to find savings to shore up their bottom lines in the face of continuing Medicare cuts. Congress just sent them a message that said: “Go right ahead, whack away.”
If you add in the postponed implementation of the two-midnight rule, it's clear that hospitals came away with some temporary victories in the latest doc fix. But those short-term wins come at a cost.
The problem of ICD-10 conversion will not go away. The CMS fraud fighters will continue to scrutinize hospital stays. And, of course, a year from now, doc pay will be up for its 18th fix.
The number of unresolved issues sitting inside that tumbling can just grew exponentially.
Follow Merrill Goozner on Twitter: @MHgoozner