Temporary SGR fix frustrates many

Spurring anger among physicians, President Barack Obama signed a bill last week preventing steep cuts to Medicare physician payments for one year after Congress failed to agree on a way to pay for permanent physician payment reform. Adding to providers' dismay, the bill also delayed the conversion to ICD-10 coding for at least a year. The new law also would partially delay enforcement of a controversial inpatient payment rule for hospitals, the “two-midnights rule,” for six months.

The Senate voted 64-35 in favor of the Protecting Access to Medicare Act of 2014, which the House approved the week before. It will be the 17th temporary patch Congress has enacted since the Medicare sustainable growth-rate formula became law in 1997.

Sen. Tom Coburn (R-Okla.) said the bill was an example of “why the American people are disgusted with (Congress)… We should be fixing this problem, instead of delaying the problem.”

The new law will freeze Medicare physician payments only through March 2015. Senate Majority Leader Harry Reid (D-Nev.) said the legislation was “not ideal,” but that he lacked the votes for a permanent solution. Without the patch, physician payments would have been cut by 24% as of last Tuesday.

Dr. Ardis Dee Hoven, president of the American Medical Association, said her organization was “deeply disappointed” with the patch. “This bill perpetuates an environment of uncertainty for physicians,” Hoven said.

Hopes were high that Congress would pass a permanent solution this year. In February, the House Energy and Commerce and Ways and Means committees and the Senate Finance Committee released a bipartisan proposal for reforming the SGR formula, but could not agree on how to pay for it.

Sen. Ron Wyden (D-Ore.), chairman of the Senate Finance Committee, asked the Senate to consider a unanimous consent to pass a permanent replacement for the SGR, to be funded by savings from winding down the war in Afghanistan.

Sen. Jeff Sessions (R-Ala.) objected, then put forward his own proposed solution of repealing the Affordable Care Act's mandate for individual health insurance, which would offset the cost of finding a permanent solution to the SGR.

Still, talk of a permanent fix hasn't stopped. “We're farther down the road than we've ever been before,” said Julius Hobson, a senior policy adviser at law firm Polsinelli, who closely follows SGR negotiations.