Congress approves one-year Medicare payment fix, extends ICD-10 deadline

Congress has issued a yearlong fix to Medicare's physician payment formula, but the fight for a permanent solution is far from over.

Medicare's sustainable growth rate formula has threatened automatic payment cuts to Medicare physicians for more than a decade. Congress on multiple occasions has approved temporary "patches" to prevent these reductions from taking effect. The most recent patch had been scheduled to expire on March 31.

Averting the cuts once again, House and Senate lawmakers approved legislation that provides a temporary solution for a year. The legislation replaces a 24% reduction to Medicare physicians with a 0.5% increase through Dec. 31, freezing Medicare payments until April 1, 2015.

It also pushes the implementation date for the International Classification of Diseases, Tenth Revision (ICD-10) back by a year to Oct. 1, 2015.

As expected, President Obama signed the bill into law on April 1.

"With the one-year patch in place, again the financial uncertainty is removed so Congress can work on the complete repeal of the SGR and put in place a long-term program that will work for all physicians," says Roger Jordan, O.D., who chairs the AOA Federal Relations Committee.

Advocacy for a long-term solution

As lawmakers continue to seek a permanent solution to Medicare's payment issues, the AOA urges members to attend its Congressional Advocacy Conference. The conference offers opportunities to meet directly with lawmakers to ensure any program changes fully recognize ODs as physicians and safeguard patient access to ODs.

"The AOA has made it clear to both House and Senate leaders that our full physician status in Medicare is non-negotiable," says AOA President Mitchell T. Munson, O.D.

"On several occasions, the AOA sought and won optometry-specific changes to advancing Medicare payment bills. It's clear that our profession is being heard loud and clear on Capitol Hill, thanks to the hard work of the AOA and optometry's army of grassroots advocates," Dr. Munson says.

Bill extends ICD-10 and other deadlines

The AOA and state affiliates had been working to help members prepare for the transition to ICD-10, originally scheduled for Oct. 1, 2014. Providers now have until Oct. 1, 2015, to prepare for ICD-10.

Many ODs had been wondering if their offices would be adequately trained in time to meet ICD-10's previous deadline for 2014, Dr. Jordan says. "We all were also concerned that the vendors could meet the deadline."

The bill also extends the 1.0 work floor on the Geographic Pricing Cost Index by a year. This provision "is crucial for those optometrists that practice in a less expensive region to keep their current reimbursement up," Dr. Jordan explains.

Lawmakers indicated they would continue to work on a long-term Medicare payment solution.

The yearlong patch "does not preclude any work from being done on the long-term fix in terms of how we pay doctors," U.S. House Speaker Rep. John Boehner (R-Ohio) said at a March 26 press conference. "I think we need to take this step first."

The AOA will monitor Congress' progress and voice any concerns on behalf of members, Dr. Jordan says. "We will not be left on the outside looking in on any programs. We are physicians and will continue to assure that status in Medicare."