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News from Washington

by Loren Bonner, DOTmed News Online Editor | May 01, 2014
From the May 2014 issue of HealthCare Business News magazine

The last 30 days have been a whirlwind with one general theme I keep coming back to as I reflect: Washington, D.C.

I traveled to our nation's capital twice this past month - first for the American College of Cardiology's annual meeting, followed by the National Association for Proton Therapy's second annual show and then to moderate a panel on telemedicine at the World Health Congress.

First, I have to say, Washington, D.C. has changed a lot since I lived there during my college days nearly 10 years ago. There's a young, vibrant feel to the city and I think it was a great location for all of these shows. (Another annual conference we attend, AHRA, will also be there this summer.)

Yet, as I reflect more on this theme, health care policy news - that had everything to do with Congress and the President - also stands out.

The Sustainable Growth Rate Formula (SGR) patch, which President Obama signed into law in early April, was very different from bills that temporarily fixed the controversial formula in years past. First, it included American College of Radiology-backed requirements for imaging, which will incentivize ordering physicians to embrace appropriateness criteria when coordinating medical imaging exams for patients. Specifically, it will deny payment to those providers who do not follow the appropriateness criteria that is meant to boost quality and cut down on duplicate or unnecessary scanning and their associated costs. In addition, the bill gives the secretary of the U.S. Department of Health and Human Services the authority to identify decision-support tools for physicians to consult when ordering imaging tests.

The new law also avoids a 24 percent across-the-board cut to provider payments and requires the Centers for Medicare and Medicaid Services to produce data that was used to justify a 25 percent multiple procedure payment reduction, instituted in 2012, to certain imaging procedures provided to the same patient, on the same day, in the same session.

The other big surprise in the bill is a provision that delays the new ICD-10 coding system until 2015. This is not the first time ICD-10 has been delayed. The reaction from providers has been a mixed bag - relief on one hand for those who didn't feel prepared, but frustration on the other for the constant delay, especially from those who worked hard to prepare this time around.

And last but not least, the somewhat shocking news that health and human services secretary Kathleen Sebelius will step down. She's certainly had a challenging job over the past five years overseeing the implementation of health care reform. I don't envy anyone in those shoes.

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