House passes ‘doc fix’ bill with one-year ICD-10 delay

The U.S. House of Representatives passed a one-year, ‘doc fix’ bill, “Protecting Access to Medicare Act of 2014” (H.R. 4302) by voice vote. The bill would preserve physician compensation levels and avoid a steep 24 percent physician pay cut set to kick in on March 31.

After a 40-minute debate on the bill, a vote was postponed throughout the morning as House GOP leaders sought to round up support. The quick voice vote means that there is no record of who voted for or against the bill.

The Protecting Access to Medicare Act of 2014, introduced near midnight on Tuesday night, would replace bipartisan legislation passed in the House earlier in the month that would permanently repeal Medicare’s failed sustainable growth rate (SGR).

It contains a contentious provision that would extend the ICD-10 compliance date one year to Oct. 1, 2015, and also would require physicians to consult appropriateness criteria when ordering advanced medical imaging for Medicare beneficiaries.

Several major physician organizations, including the American Medical Association (AMA), American Health Information Management Association (AHIMA), American College of Physicians, American College of Surgeons, American Osteopathic Association and American Academy of Family Physicians, strongly protested the bill when it came to light. Some organizations launched campaigns to spur members to lobby Congress against its passage.

The Centers for Medicare & Medicaid Services estimates that a one-year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ”This is approximately 10 to 30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,” AHIMA wrote in a statement.

John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, told Clinical Innovation + Technology that a delay would undercut the time, training and dollars providers already have invested in compliance. “ICD-10 may have questionable benefits, but the train has left the station. In delaying by a year now--it’s too late. We will lose our training and readiness. Let’s just get it done and move on.”

“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,” AMA President Ardis Dee Hoven, MD, said in a statement. 

"The SGR is in a flawed payment methodology and has been since it was created. It’s been poor policy to preserve it at this moment," Steven Stack, MD, immediate past chair of the American Medical Association and practicing emergency physician in Kentucky, told Clinical Innovation + Technology. In the context of that legislation, ICD-10 is a distraction. ICD-10 was injected at the eleventh hour and distorted the real issue which is for the first time in the modern era, we had bipartisan, bicameral agreement and over 600 physician groups saying adopt this policy. There is consensus in the elective leadership and the profession to remove the SGR. That’s the best we can get at this time. We need to put this behind us so we can focus on making care better for patients. ICD-10 added at the last minute has nothing to do with what Congress should address which is that they should appeal this horrible SGR once and for all." 

During the morning debate, Democrats argued that the doc fix bill was proposed under the radar with little debate, and postpones yet again a permanent repeal of SGR.

“It’s unfortunate that we’ve been put in this position. The organized docs of America have said no on this bill. They know, we know, the Wall Street Journal knows, that we need to fix this permanently. It’s a fraud. And both sides have committed that fraud,” said Steny H. Hoyer (D-Md.), during the debate.

Calling the bill “disappointing,” Rep. Sander Levin (D-Mich.) echoed the sentiment that the latest proposal had not been properly vetted. “It’s a product that hasn’t gone through the legislative process. There has been no public hearing, no committee hearing, no regular order.”

“I’m not ready to concede a short-term patch. Let’s keep working on a permanent solution,” Rep. Henry Waxman (D-Calif.) also said.

But, bill sponsor Joseph Pitts (R-Penn.) said failure to pass the bill could mean major reimbursement cuts to physicians, putting seniors at risk for not receiving care. “We are thinking of seniors and certainty for them. A vote ‘no’ today is a vote against seniors. We are not voting for the AMA [American Medical Association], we are voting for or against seniors today.”

Rep. Fred Upton (R-Mich.) also said that this bill is required to avoid major cutbacks. “There is no such thing as a perfect bill. Nobody wants this expiration. It hurts the physician community."

The bill must pass the Senate for it to proceed.