Long-term care providers, physicians at loggerheads over pace of doctor payment reform

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House Speaker John Boehner (R-OH)
House Speaker John Boehner (R-OH)

Long-term care and physician groups may be headed for an impasse when it comes to fixing Medicare's system for paying doctors.

The American Medical Association “adamantly opposes” any short-term fix to Medicare's Sustainable Growth Rate system, AMA President Ardis Dee Hoven, M.D., told Congressional lawmakers Monday. The AMA supports a bipartisan plan to finally achieve a permanent “doc fix,” which was unveiled with much fanfare last week.

Long-term care providers were more circumspect about that plan. The American Health Care Association/National Center for Assisted Living called the proposal “encouraging” but emphasized that legislators have not laid out a plan for how to pay for the repeal, which would lead to increases in physician payments rather than the decreases called for under the current SGR system.

Hoven's comments came as another potential plan reportedly was taking shape. Speaker of the House John Boehner (R-OH) and other Republican leaders have been considering a nine-month “patch” of the SGR as part of their proposal that would raise the nation's debt limit, according to various news outlets. Boehner and his colleagues met in a closed-door meeting Monday. Congress faces a Feb. 27 deadline to raise the debt limit.

AHCA/NCAL said it would support a longer timeframe for fixing the payment system, even if it means extending the 2% reduction in Medicare reimbursements enacted under the budget cuts known as sequestration. 

Congress needs time to carefully consider how to pay for a permanent repeal — and long-term care advocates do not want legislation rushed through, AHCA emphasized in an email Monday. Providers say they do not want lawmakers to make overly hasty decisions to offset the cost of an SGR repeal by reducing post-acute and long-term care reimbursements, which is on the table. Adjusting payment updates for some post-acute providers could lead to about $79 million in savings through 2023, according to a spreadsheet of potential SGR offsets that was distributed to lawmakers and obtained by the Bureau of National Affairs.

While extending sequestration cuts to help offset a nine-month SGR fix would be acceptable, AHCA members cannot support an extension of those cuts to offset spending that is not health-related, the association noted in an email to McKnight's.

Another prominent long-term care association, LeadingAge, has raised a separate concern. The bipartisan proposal to repeal the SGR does not address caps on therapy reimbursements, and the current exceptions to the caps are set to expire March 31.

“The therapy caps would reduce Medicare beneficiaries' access to rehabilitation services by limiting their choice of providers; by forcing them to bear 100% of the cost of care once they exceed the cap; or by self-rationing their care to avoid exhausting their benefits,” LeadingAge President and CEO Larry Minnix wrote in a Feb. 7 letter to Congress.

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