James M. Berklan, McKnight's Editor

Now, even three or four years down the road, the impression of the long-term care leader cowering like a guilty child is haunting.

He is in a U.S. Congressman’s office, figuratively handing the lawmaker a leather strap and saying, “Please don’t make it hurt too much.” One problem is that his words asking for mercy are the “child’s” opening statement. The bigger problem is that nothing’s been done that merits punishment.

But such is the life of a long-term care advocate when going up against the hospital and physician lobbies. At issue yet again is what to do about payment for the country’s Medicare physicians.

Due to the unsustainable Sustainable Growth Rate formula, doctors are to receive a 24% pay cut come Jan. 1 if nothing is done. Of course, it won’t happen.

So the worry becomes that Congress will apply some sort of fix that will ultimately take money from other providers. A lot of people have seen this coming for a long time. (Enter the meek LTC advocate above.)

A “Discussion Report” this fall from staffers for the House Ways & Means and Senate Finance committees has raised LTC concerns. On the table is a proposal to repeal the Sustainable Growth Rate, freeze doc payments for 10 years and then allow them to inch up. In the meantime, physicians could earn extra by providing desirable outcomes or using electronic health records more.

As the group once known as the American Medical Directors Association pointed out in a letter to the congressional committees, their plans could put LTC docs behind the 8-ball.

First, if rewards are going to be given to physicians for using electronic health records more, how do they cope when those around them aren’t adopting electronic health records more? And not only that, how do they cope when the government is incenting others to create more “meaningful use” of EHRs but not LTC?

There are other potential minefields to tiptoe through. Dealing with a value-based purchasing model very likely would incentivize standards that might sound sensible to some yet not mesh with LTC. How does one equitably reward care outcomes when patient improvement is merely minimal or not expected?

Beyond the fear of pirating about $150 billion from long-term care and other interests to pay for a doc “fix” like this, there’s a bigger worry: a further exodus of eldercare physicians from a pool that is already dangerously thin.