D.C. Report: Health Spending to Increase, MGMA Calls for 5010 Delay

April 9, 2013
Washington was abuzz this week with the release of the Congressional Budget Office (CBO) 2012 outlook. According to the annual report, CBO’s regular baseline (which is set based on current law) would result in $3 trillion of accumulated deficits from 2013 through 2022.

CBO Foresees Rapid Increase in Deficits, Health Spending Over Next Decade Washington was abuzz this week with the release of the Congressional Budget Office (CBO) 2012 outlook.  According to the annual report, CBO’s regular baseline (which is set based on current law) would result in $3 trillion of accumulated deficits from 2013 through 2022.  However, CBO also constructed an alternative scenario, based largely on extending Bush-era tax cuts and repealing mandatory sequestration cuts.  Observers agree these options are more politically appealing, but extending tax breaks and sidestepping sequestration would result in nearly $11 trillion in additional deficits over that period, CBO said.  For those of us in the healthcare world, the CBO revised cost estimates of the “doc fix,” estimating it would take $316 billion to correct the sustainable growth rate formula for Medicare reimbursement.  As for general spending on Medicare and Medicaid, CBO foreseesthose programs climbing to $1.8 trillion – or about 7 percent of the entire economy – by 2022.  The budget office expects Medicare spending to rise 90 percent between now and 2022 — and that’s assuming Congress signs off on Medicare cuts to physicians.

Talk of a permanent “doc fix,”was also buoyed by the CBO report, due to an accounting of how much the drawdowns in Iraq and Afghanistan could save.  Troop withdrawls would save $838 billion over 10 years, CBO says, leading many Democrats (and a growing amount of Republicans) to argue for a partial SGR fix.  According to Senate Minority Whip Jon Kyl (R-Ariz.) he believesthe pay-for is “quite likely to happen” – though his plan would use $191 billion in war savings to pay off SGR debt, not the full $316 billion that includes several years of physician payment increases.  Negotiations between House and Senate leaders on how to handle the doc fix continues next week, but they agree that a permanent solution must be found for the flawed Medicare physician reimbursement system – or at a minimum the formula should be repealed while lawmakers continue to search for a fix.

AHIMA Enters ICD-10, AMA Fray The American Health Information Management Association (AHIMA) defended against calls to delay implementation of ICD-10 this week.  In response to increased pressurefrom the AMA to halt the required implementation of ICD-10, AHIMA said providers who stop implementations to see what actions Congress takes may regret the decision.  AHIMA vice president for advocacy and policy Dan Rode urged the healthcare community to continue preparing for the transition, calling it central to the US healthcare system moving forward. “The move to ICD-10-CM/PCS is at the foundation of healthcare information changes underway in the United States,” Rode said. “Without ICD-10 data, there will be serious gaps in our ability to extract important patient health information that will give physicians and the healthcare industry measures for quality of care, provide important public health surveillance, support modern-day research, and move to a payment system based on quality and outcomes.”

In addition to sending a letter to House Speaker John Beohner, AMA executive vice president and CEO Dr. James Madara send a similar plea to HHS Secretary Sebelius. “On behalf of the physician and medical student members of the AMA, I am writing to urge you to immediately halt the Health Insurance Portability and Accountability Act (HIPAA) required implementation of ICD-10, and re-evaluate the penalty program timelines associated with the number of Medicare health IT programs underway today,” Madara wrote.

MGMA Renews Calls for 5010 Delay The Medical Group Management Association wrote a letter to HHS Secretary Kathleen Sebelius contending the HIPAA 5010 system is not working and is creating payment backlogs for many of its members.  “Should the government not take the necessary steps, many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practice,” wrote MGMA President and CEO Susan Turney, MD.  The letter went on to reiterate MGMA's request for CMS to delay enforcement of HIPAA 5010 standards until June.

CMS Updates MU Payment FAQs The Centers for Medicare & Medicaid Services this week updated previously posted FAQs on topics related to reporting periods, incentive payments and other topics. CMS highlighted five FAQs, to provide clarity on issues including how long after attestation a hospital can expect payment and an updated table explaining the reporting periods based off four scenarios.

Updated answers on to “How and when will incentive payments be made,” learn more about the EHR reporting periods for eligible hospitals participating in both the Medicare and Medicaid EHR Incentive Programs.  All 191 FAQs published by CMS on Meaningful Use.

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