Temporary SGR fix and ICD-10 delay near certain as Senate readies vote

On Monday, the U.S. Senate is scheduled to take up the temporary sustainable growth rate formula (SGR) fix and one-year ICD-10 delay that was pushed through the House in dramatic fashion on Thursday.

With the SGR formula set to kick in on April 1 and no agreement on how to pay for a permanent SGR repeal in sight, House Speaker John Boehner (R-Ohio) and Senate Leader Harry Reid (D-Nev.) reportedly worked out a plan to introduce a one-year delay for the SGR in order to avoid a 24 percent cut to Medicare physician payments starting on Tuesday.

To ensure passing yet another SGR fix rather than a full repeal would be more palatable, the plan also picked up several provisions from the House and Senate bills to permanently replace the SGR, as well as from some stand-alone bills. Among these were:

• A one-year delay of ICD-10 implementation
• A realignment of the Medicare sequester cuts for 2014
• A half percent reimbursement increase for Medicare physicians through the end of 2014
• A delay in implementation of the two-midnight rule for inpatient stays until the end of March next year
• Additional money for Medicare payments to rural hospitals and those that primarily care for Medicare patients
• Value-based purchasing for skilled nursing facilities

With time running short, the bill was introduced under a suspension of the rules, which meant it needed a two-thirds majority to pass. But the American Medical Association (AMA), which backed the permanent repeal of the SGR put forth by the Senate Finance Committee, came out publicly against the temporary fix. This was despite the fact that not supporting the fix would almost certainly mean that AMA members' Medicare payments would be interrupted starting on April 1.

"By extending the Medicare provider sequester and 'cherry picking' a number of cost savings provisions included in the bipartisan, bicameral framework, the 'Protecting Access to Medicare Act' actually undermines future passage of the permanent repeal framework. Further, it would perpetuate the program instability that now impedes the development and adoption of health care delivery and payment innovation that can improve health care and strengthen the Medicare program,” stated AMA President Ardis Dee Hoven, M.D. "We urge the House and the Senate to continue to pursue bipartisan negotiations on permanent SGR repeal legislation and for both chambers to oppose 'The Protecting Access to Medicare Act.'"

The loss of AMA support along with a late push by Senate Finance Committee Chairman, Ron Wyden (D-Ore.) to seek passage for his committee’s permanent SGR repeal proposal threatened Democratic support for the SGR fix. Rather than pulling the bill for a lack of support, the House leadership took the unusual move of bringing it up for a voice vote without alerting most members.

In a voice vote, only representatives on the floor at the time have a chance to vote. They are not called up individually to register their vote as they are in a traditional roll call vote. Since few legislators sit in the chamber during debate, most missed the vote and were surprised to find it had already taken place when they later entered to vote on an unrelated measure.

Senator Reid did not hold a vote on the fix the same day it passed the House, which may indicate that the Democratic leadership in the Senate needed the weekend to soothe ruffled feathers and firm up support for a fix. When asked about the SGR fix on Thursday, he praised the Finance/Sen. Wyden permanent repeal legislation and offered reassurances that work toward a permanent SGR repeal would not stop.

“The patch that we have is imperfect, but it is something that will take care of things,” Reid told the political news site The Hill. “I am disappointed we didn’t get a permanent fix, but we should be very happy about what we have done.”