Daily Editors' Notes

A 'Super' physician-pay fix in the making?

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James M. Berklan
James M. Berklan

I suppose it's only fitting that during the week of the season's biggest football game, Washington healthcare wonks are discussing a potential huge punt of their own.

As NFL fans and commercial watchers around the world are eagerly anticipating the Denver Broncos and Seattle Seahawks butting heads on Sunday in New Jersey, healthcare officials are still pondering what to do about Medicare payment for doctors.

Under the current Sustainable Growth Rate payment formula, which is the law of the land, physicians are scheduled to see payment cuts of about one-fourth of current reimbursements. Yes, monster cuts have been threatened for a long time, and, no, the cuts never come. And never will come.

That's what has long-term care execs fidgety. The docs are not going to ever experience such massive cuts. That means something else is going to have to pay for their future funding (and indeed, higher levels of funding).

Members of Congress have been working on a 10-year repeal of the SGR. This is better than doing nothing and definitely better than the annual or biennial “fixes” that Congress has wobbled to in recent years.

But a 10-year repeal also would carry a huge price tag. A really, really huge tab. Good luck getting that one through.

Nonetheless, it has done little to lessen LTC leaders' feelings of vulnerability and worry.

Any plan that would ease the load of paying physicians any more than absolutely necessary would take a little tension out of the LTC lounge.

Enter some former leaders of the Centers for Medicare & Medicaid Services. Their solution is neither the status quo nor a 10-year suspension of the doc pay formula. Instead, they're proposing a 5-year repeal.

Call it a quick-kick or putsch punt instead of a full-blown Ray Guy blast off the foot. But it's still a punt.

It would amount to a stay of execution for whatever group winds up “helping” pay for the physicians' fees.

But it also could lead to a way out of a mess. A five-year breather would give time for some of the alternative payment methods now being tested to mature, shrewdly noted Gail Willensky, the CMS administrator from 1990-92. A cure might come out of one of these experiment said Willensky, now a senior fellow at Project Hope.

She, along with Mark McClellan, MD, PhD, who was CMS administrator from 2004 to 2006, endorsed the five-year plan at a briefing on Friday.

Yeah, I'm not overly optimistic about the odds of that happening, either. But, hey, it's Super Bowl week. A punt isn't totally unexpected.

Too bad lawmakers don't emulate other action we'll see on the field Sunday and pass something, or at least get down to tackling the problem head-on — once and for all.

James M. Berklan is Editor at McKnight's.


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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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