House Passes One-Year ‘Doc Fix’
On March 27, the House passed a one-year “patch” to the Sustainable Growth Rate (“SGR”) that averts a 23.7% cut to Medicare physician payment rates scheduled to start on April 1. The House bill (H.R. 4302) also includes Medicare extenders, such as the Low Volume Hospital adjustment and outpatient therapy caps and some policies that traditionally have not accompanied prior SGR patches.
The bill would allow CMS to extend the 2-midnight rule and corresponding prohibition on certain recovery audits until April 1, 2015. Last month, CMS delayed enforcement of the hospitals 2-midnight rule and extended limits on Recovery Audit Contractors (“RACs”) until September 30, 2014. During this time, RACs are not able to review short stay inpatient hospital stays.
The bill delays implementation of the ICD-10 coding system until October 1, 2015. Additionally, the scheduled Medicaid disproportionate share (“DSH”) cuts would be delayed one year to 2017 but extended to 2024. Under current law, the cuts were scheduled to end in 2023. The bill also includes a study on children’s hospital graduate medical education (GME) training.
The Senate is scheduled to vote on the one-year SGR patch on March 24. It has been working on a longer-term measure (S. 2110), but has been unable to reach an agreement on paying for it ahead of the March 31 deadline. By passing a one-year extension, lawmakers will be forced to revisit the SGR issue around the same time the current debt ceiling extension expires in March 2015 unless action is taken sooner.
RACs Release Fiscal 2012 Report to Congress
On March 27, CMS released its fiscal 2012 report to Congress on the Medicare RAC program. According to the report, RACs returned $1.9 billion to the Medicare Trust Fund in FY 2012. The report indicates that more than 91% of the overpayments, which totaled in excess of $2 billion, came from inpatient hospital claims. The number of claims RACs reviewed in FY 2012 increased over FY 2011.
GOP Senators Ask CMS to Protect Medicare Advantage Pay
Also on March 27, five Republican Senators asked CMS to use “all the policy levers at its disposal” to keep Medicare Advantage payments flat in 2015. The letter to CMS Administrator Marilyn Tavenner comes prior to CMS announcing their finalized payment rates for private plans on April 7, 2014. In February, CMS proposed an estimated cut of 5.9% due to ACA provisions to bring payments in line with traditional Medicare, historically low growth in health spending and other annual adjustments.
CDC Report Shows Hospital Infections Still High
On March 26, the Center for Diseases Control (“CDC”) released data showing hospital-acquired infections remain high despite progress with some of the most common types of complications. Two reports, reflecting estimates from 183 facilities as well as data from a national tracking system, showed that 1 in 25 patients contract at least one infection during a hospitalization. In 2011, the most recent year for which numbers are available, that number totaled nearly 722,000 infections and about 75,000 deaths.
Bills Introduced This Week in Washington
Rep. Kathy Castor (D-FL) introduced legislation (H.R. 4282) that intends to create a $25 million CMS grant program that would allow hospitals in states with a low ratio of medical residents to apply for matching funds to support increases in graduate medical training slots.
Senator Robert Casey (D-PA) introduced a bill (S. 2154) that would amend the Public Health Service Act to reauthorize the Emergency Medical Services for Children’s Program. The program was originally authorized in 1984 and is dedicated to improving emergency medical care for children.
Next Week in Congress
The Senate will vote on March 31 on the one-year SGR patch. The legislation will have a 60-vote threshold. The House will vote next week on a bill adding hours to the ACA’s definition of full-time work. Under the legislation, sponsored by Rep. Todd Young (R-IN), full time would be 40 work hours a week instead of 30.
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