Medpac (Medicare Payment Assessment Commission) is an independent entity that advises Congress on changes to the Health Care payment schemes.  Their annual report to Congress usually sets Medicare payment strategies for the coming year (FY 2012) http://www.medpac.gov/documents/Jun11_EntireReport.pdf

This June’s report is making a more serious effort to restructure payments with an eye towards a more primary care focused scheme.  To fit within the existing Medicare Part B budgeting guidelines, Medpac is urging Congress to cut physician payments for Imaging and many tests.

Note that E&M services, in the aforementioned pdf, and Major Procedures have increased <35% over the decade – less than a 3% annual growth rate.

The report  (page 11)goes on to recommend enhanced payments for clinicians who care for the chronically ill – with an emphasis on encouraging coordinated care – clearly a call for better pay for LTC clinicians:

• Appropriate evaluation, management, and coordination of patients’ care (among providers and across sectors) are especially crucial for elderly and disabled patients with chronic conditions. Future changes to the payment system for physicians and other health professionals should recognize the importance of these activities in ensuring comprehensive, population-based care for Medicare beneficiaries. Toward that end, we envision some shift of resources from procedural to cognitive services—particularly for physicians and health professionals who focus on managing patients with chronic conditions. This shift would help overcome the relatively lower reimbursements for primary care and ensure a workforce with greater emphasis on generalists. Although payment rates for primary care services (and E&M services, in particular) have increased over the last several years, a concentrated realignment of the payment system is still needed.

The report also goes on to devote the entirety of Chapter 5 (pg 119) to ‘Coordinating Care for Dually Eligible Beneficiaries’.  This chapter focuses on new strategies to incent the provider community to manage this population in a more cost effective manner.  Some of the data and findings comes from a presentation ECP’s Medical Director, Robert Wells, MD made to Medpac staff in 2010.

For those of us who work in the LTC Medical community, all one can say is – it’s about time.