New House SGR Bill Devoid of ICD-10 Language, Vote Soon

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The U.S. House of Representatives on March 26 expects to vote on a Medicare physician reimbursement arrangement that would replace the current Sustainable Growth Rate formula. The bi-partisan bill being pushed by top leaders currently has no language that could lead to a further delay in the Oct. 1, 2015 ICD-10 compliance date. However, there is no guarantee that will hold.

The replacement reimbursement arrangement would give physicians treating Medicare patients an annual payment increase of 0.5 percent for the next five years, with value-based payments starting after that time. The legislation, H.R. 2, also calls for a further delay in enforcement of the “two-midnight” rule for hospital payments, pushing it out to Sept. 30, 2015.

The bill includes several major health information technology provisions that are in legislation recently introduced by Rep. Michael Burgess (R-Texas).

Also See: EHR Interoperability to be Part of SGR Debate in Congress

Language from the Burgess bill includes declaring a national objective that interoperable electronic health records be nationwide by the end of 2018, including providers possibly attesting that they are not disabling EHR functions to limit interoperability. Further, the Department of Health and Human Services would establish metrics to track progress toward interoperability and would examine the feasibility of developing a program to aid providers in comparing and selecting certified EHRs.

The Burgess language also incorporates reporting for meaningful use, value-based modifiers, the physician quality reporting system, and a new report on resource use into a single new reporting program called the Merit-Based Incentive Payment System, or MIPS. The resource use reporting would enable physicians to report their role in treating a beneficiary, says Jennifer Pollack, a government affairs representative at the Medical Group Management Association.

EHR meaningful use penalties would sunset at the end of 2018. However, MIPS, which is a proposed new program that has not yet been designed, could include payment adjustments (penalties) for programs within MIPS, which may include further stages of meaningful use.

So far, a vote on Thursday in the House looks firm, Pollack says, and Republican leaders hope to keep the bill clean and free of amendments. Whether the Senate votes on the bill soon after the House or when it returns in mid-April after a recess is not yet known. There is not yet much indication of the strength of Senate support, although Sen. Orrin Hatch (R-Utah), chair of the Finance Committee, strongly supports the legislation.

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