July 18, 2025
McKnight's Long-Term Care News
With the initial jolt of this administration’s first physician pay rule proposal wearing off, long-term care doctors are getting ready to enter a new era of oversight.
For the first time, the federal government will be paying physicians using two conversion factors. One will reward qualifying participants in Advanced Alternative Payment Models (APM); the other will not give the same amount to non-qualifiers. The APM crowd will receive a pay bump of 0.75% to their conversion factor, three times what non-qualifiers will get.
“It makes sense if you’re trying to get more people involved in advanced payment models,” said Alex Bardakh, senior director of advocacy and partnerships for PALTmed, the association of long-term care medical directors. “It could move the needle. Any time you have a pay difference, it will force people to ask questions. If you’re in a small group and that doesn’t allow you to leave money on the table, you’ll start to ask questions.”
Bardakh noted there’s already been a push toward advanced payment models, especially in long-term care.
“I think it’s typical to provide incentive dollars to go in a direction everyone wants to go,” he said. “The Centers for Medicare & Medicaid Services and the federal government have been advertising this for a while. Value-based models are the future of healthcare.”
Seeking permanence
He feels the other remarkable part of the physician pay rule proposed Monday was the tacit recognition that telemedicine expansion should continue, possibly permanently.
“The telehealth provisions are important, particularly that they moved the coding for some provisions from to permanent. They’re allowing more telehealth with no limitations,” Bardakh explained. “You can do your medically necessary visits as often as you like. We’d been fighting one limit that said every 14 days at one point. It just didn’t make any sense.”
He emphasized, however, that the telehealth services extension needs to be made permanent or at least extended again, and quickly. Current provisions are valid only until September, when a Continuing Resolution expires. He is confident that the legislative will to get it done exists.
“I think the entire world of medical specialities and beyond have kind of gotten accustomed to using telehealth,” he observed. “There’s a lot of support for telehealth in Congress. They’ve all said they’ve personally benefitted from this, so I think that’s a good sign.”
Joining in the optimism were leaders of the American Telemedicine Association.
“The telehealth and digital health provisions included in this draft rule clearly indicate strong commitment from [executive branch leaders] to modernize our healthcare system and integrate technology-enabled services to better reflect how care is delivered today,” said Kyle Zebley, ATA Action executive director and senior vice president of public policy at the ATA, in a statement.
Zebley also hailed the “positive steps forward for virtual care” regarding the Medicare Diabetes Prevention Program and additional payment codes for remote monitoring.
A permanent new definition for “direct supervision” that allows real-time audio-visual presence also earned his praise.
