Medicare reform proposal needs fixes for long-term care physicians, AMDA says

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Prospective Medicare changes regarding physician payments might unfairly penalize doctors working in long-term care settings, according to a prominent medical directors association.

AMDA-Dedicated to Long-Term Care (formerly the American Medical Directors Association) registered its concerns in a Nov. 12 letter to leaders of the Senate Finance Committee and House Ways and Means Committee. AMDA was responding to a discussion draft of legislation to repeal Medicare's physician payment formula and enact other Medicare payment reforms.

A repeal of the Sustainable Growth Rate — the formula for determining Medicare payment rates for physicians — would mean that a new system would have to be implemented. This system likely would tie payment rates to quality measures, and AMDA is concerned that current and proposed measures are not a good fit for long-term care physicians.

For example, the government has set incentives for physicians to meet “meaningful use” thresholds for electronic health records. However, LTC physicians are practicing in settings that have not adopted EHR technology on a broad scale, in large part because they have been excluded from government programs making adoption more affordable. Tying physician payments to meaningful use requirements would therefore harm LTC doctors, AMDA argued in its letter.

The letter also raised concerns regarding a potential value based purchasing model. Here, incentive payments would be made to physicians who meet performance standards. These standards might not apply in LTC settings, where “patient improvement is minimal or not expected,” AMDA noted.

Click here to access the full letter.

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