SGR Repeal Whets AMA's Appetite

The Congressional repeal of the Medicare sustained growth rate formula for calculating doctors' payments has the American Medical Association energized and ready to push for more reform. First up is trying to delay or stop the implementation of a new billing code system the group says will be costly for its members. It's known as ICD-10.

As the American Medical Association kicked off its annual House of Delegates (HOD) meeting in Chicago this week, the scent of victory was in the air.

The group hopes to build on its momentum to push for still more changes in laws and policies that the AMA believes threatens its members’ profession.

Those include scaling back the “meaningful use” of electronic medical records requirements that Washington holds out as a necessity to get maximum Medicare reimbursements.

Debating the merits of several proposals to refine or eliminate that requirement, a Texas delegate said the measure is hard on rural practitioners who are solo or in small groups. Seventy percent of those doctors do not have EMRs, he said.

Others said some physicians, particularly if they are near retirement, decide to forgo getting records and just accept the lower Medicare payments.

Also on the agenda is doing away with the Medicare Independent Payment Advisory Board, a body Congress set up to make recommendations on how much physicians should get for services.

There was much self-congratulation for the successful lobbying effort that finally led Congress to repeal the much hated Medicare Sustained Growth Rate (SGR) formula that had resulted in an annual need to enact legislative emergency fixes in payment schedules.

In his final address as AMA president, Robert Wah, MD, on Saturday said “I’m proud to say the elimination of the SGR happened our watch.”

“It wasn’t a ‘doc fix’,” he added, “it was Medicare that needed fixing, not doctors.” As part of its lobbying effort, physicians made more than 60,000 phone calls to legislators “and fired off nearly a quarter-million emails to their elected officials.”

Though more than 700 state and specialty medical associations were participating, the AMA led the charge, he said.

“We burned rubber and we smashed through the barriers to success,” Wah said, to loud applause.

But as some delegates pointed out the following day, though Congress finally repealed the SGR, it has done nothing to reverse the so-called sequestration cuts, an across-the board 2% cut in Medicare payments that was supposed to be a temporary federal budget fix, but shows no signs of going away.

Nor has it listened to appeals from the AMA and other groups to delay or cancel the implementation of the International Classification of Disease codes that will take effect this October, an iteration of billing codes to be known as ICD-10.

Many delegates feel strongly that the change will be costly. The new set of codes will be far more detailed and numerous, an effort to make them more precise and fair.

But physicians see nothing but rejected claims due to coding confusion ahead.

Several delegates have introduced resolutions calling for delaying ICD-10 until there is more analysis of its potential financial impact on physicians.

“We believe ICD-10 will further disrupt physician practices,” Wah noted, saying one study shows claims acceptance rates would fall from 97% to 81%. In other words, that 1 out of every 5 Medicare claims would be rejected, with disastrous financial and cash flow problems for some physicians.

If the delay does not happen, Wah said, CMS should at least enact a grace period in which providers would be guaranteed at least the payments they would have received under ICD-9.

A repeated theme throughout the first 2 days of the meeting was that the AMA needs to be involved when practice-changing policies are discussed.

“It’s time we stop having tools and products with surprising limitations and deficiencies simploy thrown over the transom to us,” said AMA’s chief executive, James Madara, MD. “We need to be at the table and shape the future from the get-go,” he said.