Archive for February, 2012|Monthly archive page

The Fix Is In… for 2012

In Uncategorized on February 29, 2012 at 5:12 pm

The House and Senate have both voted to approve, and the President has signed into law, legislation preventing the scheduled 27.4% SGR related cut from taking effect on March 1.   While many issues are in fact addressed in this legislation – ranging from outpatient therapy caps to ambulance add-on payments; from the governments provision of bad debt payments to insitutions to the payment of the technical component of certain pathology services, etc…, by far the most anticipated and relevant item impacted by the legislation is the Medicare Physician Fee Schedule rates:

Physician Payment Rates – This provision prevents a 27.4 percent cut in Medicare physician payment rates slated to begin on March 1, 2012, and instead freezes payment rates at their current level though December 31, 2012.  This provision also requires the Government Accountability Office (GAO) and HHS to submit reports to assist Congress in the development of a long-term replacement to the current Medicare physician payment system.

Physicians can breathe a sigh of relief, as physician payments are safe for the remainder of 2012…  but a permanent fix is an ever increasing necessity, for now, physician practices will face a mounting 35% payment threat from Medicare in 2013, absent additional furture Congressional intervention.


It’s Official – ICD-10 Has Been Delayed

In Uncategorized on February 21, 2012 at 8:55 pm

It’s no longer a mere possibility; HHS has confirmed its intent to delay the ICD-10 compliance deadline, as announced in HHS’s February 16th press release:

As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10):   “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead,” Secretary Sebelius said in the press release. “We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our healthcare system.”

The American Medical Association (AMA) supports the delay. “The timing of the ICD-10 transition could not be worse for physicians as they are spending significant financial and administrative resources implementing electronic health records in their practices and trying to comply with multiple quality and health information technology programs that include penalties for noncompliance,” Peter W. Carmel, M.D., president of the AMA, said in a February 16 press release.

Though the new deadline remains unclear, CMS previously confirmed CMS Acting Administrator Marilyn Tavenner’s statement that the agency will use the rulemaking process when revisiting the ICD-10 implementation timeline. The rulemaking process can be lengthy, so it may well be awhile before a firm date is established.

adapted from, and HHS Press Release (

Happy Valentine’s Day – CMS’ Present To Providers: Potential Delay in ICD-10 Timeline

In Uncategorized on February 14, 2012 at 7:49 pm
The acting head of the CMS on Tuesday signaled that the agency will extend the timeline on ICD-10 implementation.
Over the past few months, the American Medical Association has been actively working toward delaying the implementation of ICD-10.  In mid-January, a letter from AMA Executive Vice President and CEO James L. Madara, M.D. to House Speaker John Boehner (R, Ohio) stated that, “[r]equiring doctors to use ICD-10 would offer no direct benefit to patient care.”  That letter further stated that “requiring all physician practices to use new diagnosis codes starting Oct. 1, 2013, also would interfere with concurrent efforts by doctors to implement electronic medical records and satisfy other Medicare quality improvement requirements.”
After recently speaking to attendees at the American Medical Association Advocacy Conference in Washington, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will “re-examine the timeframe” through a rulemaking process. She did not say when that rulemaking process will begin but said the CMS would send details about the process in the coming days. “There’s concern that folks cannot get their work done around meaningful use, their work around ICD-10 implementation and be ready for exchanges,” Tavenner said. “So we’re trying to listen to that and be responsive.” Separately, Tavenner said she the CMS has had “good results” with accountable care organization applications and expects to make an announcement about selected applicants “at the beginning of the second quarter of this year.”
For more information on ICD-10, please see The Centers for Medicare & Medicaid Services’s webpage, at

2012 Medicare Physician Fee Schedule Is In the Crosshairs Again… AKA, “The Perils of The SGR”

In Uncategorized on February 8, 2012 at 3:21 pm

Although most of us were not around during the era of silent movies, many of you may be familiar with a genre of movie referred to as a serial motion picture….  One of the more famous of this genre was titled, “The Perils of Pauline.”   In this series, the heroine, Pauline, would be put into a perilous situation (i.e. tied to the railroad tracks with a fast approaching train, tied to a barrel filled with explosives, etc.) and during the course of the installment, Pauline would miraculously escape near certain death at the last possible moment.  Each installment would end with words to the effect, “Tune in Next Week.”

Anyone familiar with “The Perils of Pauline” series cannot help but recognize the parallels between Pauline and healthcare providers as we watch our government deal with theSGR problem.  Every few months, it seems, Congress waits until the last possible moment to fix the SGR cut and avoid the financial calamity that would ensue if Congress allowed the cut to take effect. 

As we all know, in the latest “Perils of SGR,” Congress voted to delay any resolution of the SGR – and the potential 27% reduction in the Medicare Physician Fee Schedule — in late 2011.  However, that “fix” was only for two months and we were all told to, “Tune in next month,” as our intrepid Congress attempts to once again step in at the last minute to avoid yet another possible cut in physician fee schedule payments on March 1, 2012.  Unfortunately, whereas “The Perils of Pauline” was a movie, the perils of the SGR cut are all too real.

On January 24th a House-Senate Conference Committee met for the first time to begin formal work on resolving the SGR differences between the House and Senate.  Although this was the first meeting by the Representatives and Senators, their staffs had been meeting regularly leading up to this meeting.  The Conference Committee met again on February 1st and 2nd, and additional meetings are anticipated over the next few weeks, during which committee members are to present all ideas and solutions. 

Representative Renee Ellmers (R-NC), a freshman Member of Congress on the Conference Committee (and a healthcare executive prior to being elected to Congress in 2010) suggested a two-year extension for the SGR fix, thus giving the Congress time to find alternate solutions.  Follow-up remarks made by several members of the Conference Committee indicated that there was at least some bi-partisan interest in coming up with a permanent fix to the SGR rather than another in the long series of temporary fixes. 

The stumbling block for enacting a permanent SGR solution has not been the lack of an alternative formula, but rather how to pay for any fix the Congress might adopt.  Current estimates are that adopting a permanent fix would increase the federal deficit by approximately $300 billion over the next year unless corresponding spending reductions were made to offset the debt. 

The AMA and some other organizations have suggested that money saved by the ending of the war in Iraq could be used to pay for the SGRfix.  The current federal budget (which projects spending out for 10 years) assumed that theIraq war would go on for several more years and money was budgeted for that purpose.  However, with the ending of the war, the money previously budgeted will no longer be needed.  Therefore, from a budgeting standpoint, this money could technically be redirected to pay for the SGR fix, rather than being set aside for the war inIraq.  Doing so would not increase the projected federal deficit beyond current estimates as this would be viewed as a reprogramming of dollars already budgeted for another purpose.  It remains to be seen whether the Congress will pursue this budgetary line of reasoning or not. 

Although it appears unlikely that Congress would allow the 27% SGR-related cut to go into effect on March 1, there are no guarantees.  Stay tuned for the next installment…   

Adapted and reprinted with permission of Bill Finefrock, Washington Report – January 2012.