When Senate Majority Leader Harry Reid, D-Nev., kicked off the three hours of debate prior to voting on the Protecting Access to Medicare Act of 2014 by saying “this legislation is not perfect, it’s not ideal,” that statement quickly turned out to be quite euphemistic.
"It's a sham. It's a lie. It's nothing but gimmicks. It's corruptible. There's no integrity in what we're getting ready to vote on," said Sen. Tom Coburn, MD, R-Okla., "We're not fixing the problem today. We’re taking a big old can and kicking it down the road and, worse than that, we're not even being truthful about what we're doing."
The idea that the bill is full of budget gimmicks -- perhaps most notably the notion that Congress will actually adhere to the Bipartisan Budget Act of 2013 to get a handle on Medicare spending -- was a common theme.
Calling SGR a "Medicare migraine," Sen. Mark Warner, D-Va., said, "it's time for this Senate to take two aspirin and get rid of this migraine," and urged that the U.S. Senate has a remarkable opportunity to score a twofer by ending the SGR fiction and eliminating OCO, the Overseas Contingency Operation, which some members of Congress proposed using to fund full SGR repeal.
"We will once again avoid the opportunity to get rid of some budgetary fakery that makes some of our efforts that may be legitimate seem illegitimate because we can’t clean up our books," Warner continued. "What takes the cake is what passes for rational accounting and scoring practices in the federal government."
Sen. Jeff Sessions, R-Ala., said the "plain financial truth" is that the temporary Sustainable Growth Rate patch, which postpones for another 12 months a final decision about the scheduled 24 percent pay cut to physicians treating Medicare patients without determining a way to pay for it violates the Bipartisan Budget Act of 2013 Congress put in place only three months ago.
"We're just going to take care of the doctors who need their money and we’re not going to pay for it," Sessions said. "It violates the budget."
What’s more, the “total cost of the patches exceeds the cost of repeal,” Warner added. The Congressional Budget Office's most recent estimate of the overall cost to reform SGR is $116 billion. The U.S. has already spent more than $146 billion on temporary patches.
Sen. Ron Wyden, D-Ore., explained that all sides agree the current Medicare payment system doesn't work well for any stakeholders: doctors, seniors, or taxpayers. “It’s time to end this fiction and wipe SGR off the books."
"I think there is a growing awareness that simply spending what we already have and punting on the need to fix the urgent structural problems, it can’t be ducked much longer," Wyden said. "I have to be concerned that patch 17 will lead to patch 18, and 19. The reality is if all you do is take what you've got and extend it, we’re not going to turn this around."
Congress essentially had two options: The temporary fix it voted in favor of Monday, or "we could really take care of it," said Sen. Benjamin Cardin, D-Md.
Coburn explained that Congress has missed the SGR deadline in the past and, while it does create extra work for doctors and CMS, all parties also get back on track.
Nary a mention of ICD-10
Perhaps if the Senate had voted down the bill, regrouped, come back with another stab at permanent SGR repeal, someone would have noticed Section 212 saying that HHS cannot mandate ICD-10 as the standard code set before Oct. 1, 2015.
Instead, both the House and Senate passed the bill with not a single elected official from either side even mentioning ICD-10, let alone proposing to amend or remove Section 212. As loose an estimate as this may be, CMS itself put the cost of delaying the code set conversion between $1 billion and $6.6 billion in total and Resultant founder Joe Lavelle, a healthcare consultant, projected that waiting another year could cost his clients, depending on size, anywhere from $500,000 to $3 million each.
Yes, these are several of the dissenting voices raging against legislation that did, in fact, pass -- but where the picture of why that happened gets even more abstract is among the people who voted in favor of it.
Take Rep. Nancy Pelosi, D-Calif., for instance. The Democratic Leader actually spoke the words "it's the wrong way to go. It does not address the underlying problem. We could have done that. We've been trying to do it for 10 years," and "I, myself, come down on the side of supporting the legislation,” during a speech on the House floor last Thursday.
Why, pray tell?
"The Republicans will say this is because of the Affordable Care Act, and I just don't want to give them another opportunity to misrepresent what this is about. If the Affordable Care Act never existed, we would still be here debating SGR. They are two separate subjects,” Pelosi continued. “But as we know, any excuse will do to undermine the great legislation that the Affordable Care Act was about."
Back in the Senate, meanwhile, Orrin Hatch, R-Utah, suggested that Congress had "a historic opportunity" to do something that would help the American people and to tackle it with broad bipartisan support.
Alas, Hatch did not appear to consider the Protecting Access to Medicare Act to be that.
"I'm not going to make the perfect the enemy of the good," Hatch said, adding, "I plan to vote in favor of the SGR bill today."
It would appear that Coburn -- who previously tried to get ICD-10 delayed via a proposed amendment to the Farm Bill in May of 2013 -- was not so willing to relent.
“The bill we have on the floor is one of the reasons why I’m leaving Congress at the end of this year. There's no courage, no guts," Coburn said. “We have a payment system that's not good for patients or providers, it can’t be fixed in a weekend. If we don't fix it, we don't deserve to be here. There’s no credibility left, no legitimacy left if we pass this bill. It’s all a pack of untruths.”
The Protecting Access to Medicare Act is neither the first nor will it be the last piece of legislation, healthcare-related or otherwise, to come under a hailstorm of fire launched by opponents, but many in the industry are left jaw-dropped and wondering: How did ICD-10 even get pulled into this bill at the last minute, anyway?
This analysis first appeared on Government Health IT, a sister publication of Healthcare IT News.
