Docs might get a raise, and long-term care might get a bill

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John O'Connor
John O'Connor

Major League teams don't celebrate World Series victories midway through the season. But politicians do the equivalent all the time. Consider a revised Medicare payment plan that was joyously unveiled on Thursday.

As McKnight's reported, bipartisan leaders from the Senate and House announced a two-pronged way to replace Medicare's Sustainable Growth Rate formula for physician payments.

The SGR repeal and a newly minted Medicare Provider Payment Modernization Act (H.R. 4015) would collectively ensure a 0.5% payment update for five years. If you're a physician, that has to look a whole lot better than the 27% pay cut that was about to kick in.

In addition, the system for physician-quality reporting would be consolidated. So would the electronic health record and value-based modifier programs. The agreement also mentions that the bill “implements a process to re-base misvalued codes” and “requires development of quality measures in close collaboration with physicians.”

To be fair, this compromise will likely prevent many doctors from fleeing the Medicare program. That's all but certain if major Medicare funding reductions are carried out. And barring yet another patch on the so called “doc fix,” that was about to happen.

But there are a couple of teeny little problems with the proposed fix of the doc fix. One is that the agreement fails to address how all this new wonderfulness will actually be paid for. Nor does the proposed legislation include funding for a package of Medicare policies — known as extenders –— that fund therapy services.

If you are a long-term care provider worried that you'll eventually be paying a price for this agreement in principle (via reduced Medicare funding), you have a legitimate concern.

To further complicate matters, it does not appear that the proposed legislation is what you might want to call healthcare-reform friendly. Many of the people familiar with its particulars have concluded that it would introduce byzantine clinical record keeping rules, while retaining incentives for physicians to maximize services.

So to sum up, our lawmakers have announced a plan without determining how to pay for it. They will very likely cut reimbursement to long-term care operators once the numbers actually need to be dealt with. And by the way, healthcare may become more complicated and costly as a result.

Yes, the so-called doc fix may get resolved. But it appears long-term care operators may get fixed in a way that's more familiar to veterinarians.

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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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