One step forward, two steps back

During a college internship, a mentor once told me that journalists are born procrastinators. It’s not out of laziness, he said. Writers just like to mull over ideas in their heads until the very last moment, and many simply thrive on deadline pressure.

After the last couple months, though, I think Congress has taken the mantle of champion procrastinators.

Just before a March 31st deadline that would have brought a 24 percent cut in Medicare payments to physicians, Congress passed a “patch” that temporarily suspended the flawed Medicare sustainable growth rate (SGR) formula. You see, they simply needed more time to work on a permanent fix to replace the SGR. How long does such a fix take? The latest patch marks the 17th time in 11 years that Congress has delayed the SGR. I suppose it’s hard to be motivated by deadline pressure if you can keep punting the deadline.

In a statement, American Medical Association (AMA) president Ardis Dee Hoven, MD, said the bill “unwisely extended a fiscally irresponsible pattern of congressional procrastination.”

Tied into the SGR patch was another delay, this one pushing back implementation of ICD-10 code sets until at least October 2015. This transition has seen its own series of delays, and while the AMA actually supported this latest implementation pushback, other organizations expressed their disapproval. The American Health Information Management Association strongly criticized the delay, and pointed to estimates that found the one-year pushback of ICD-10 would cost between $1 billion and $6.6 billion.

So what did the bill get right? Those who understand the importance of cutting down on inappropriate medical imaging were happy to find the bill also contained a provision requiring providers to consult physician-developed appropriateness criteria when ordering advanced imaging. It’s a step in the right direction that should help utilize healthcare resources more efficiently and is in line with a broader transition from volume-based care to value-based care.

Optimizing care delivery and resource management will be essential in the years ahead, as the changing demographics of the U.S. will add a substantial burden to the healthcare system. As our cover story this issue shows, the aging population will mean more people with Alzheimer’s disease, cardiovascular disease and other conditions for which old age is a risk factor. This challenge will require a greater sense of urgency than we’ve seen with issues like the SGR.

And as for finally fixing the Medicare payment formula or implemented ICD-10? Relax, we’ve got until 2015.