Specialty physicians have indicated they are reconsidering participating in the Medicare program in light of the combined effect of the Independent Payment Advisory Board (IPAB) and sustainable growth rate cuts (SGR), which will severely threaten Medicare beneficiary access to innovative therapies and specialty care.
Because health care reform failed to come up with any
solution to Medicare’s reimbursement formula for physicians, doctors and
patients have been subject to a series of patches and “fixes” with no real end in sight.
Because of these looming cuts and haphazard, temporary fixes, doctors have had to make hard choices in their budgets,
resulting in less access to care for Medicare patients. And not knowing what
Congress will do on the SGR in December with a huge percent cut looming, patient
access will continue to be in peril.
Given this dynamic, it is almost unconscionable that there
is yet another mechanism to squeeze the Medicare community lurking around the
corner, in the form of the IPAB.
The IPAB is a 15-member
board of nonelected officials created to recommend Medicare spending reductions
in order to reduce the per capita rate of growth in Medicare in years when
spending exceeds a targeted growth rate. These unelected individuals will have
the authority to make significant changes to Medicare and
thereby influence important health care decisions.
The Alliance of Specialty Medicine believes that these
decisions must not be made by individuals with little or no clinical expertise,
resources or the oversight required to protect seniors’ access to care. Rather,
Congress should be the entity to legislate Medicare policy, not the IPAB.
Consideration of the IPAB’s recommendations sets a dangerous
precedent for overriding the normal legislative process. The fast-track rules
for consideration are so onerous and unrealistic that Congress would not have
any real opportunity to come up with an alternative set of cuts to those
endorsed by the IPAB, much less the 60 votes needed in the Senate to pass them.
Yet, the IPAB’s recommendations have the force of law if Congress fails to act
on its recommendations.
Medicare reimbursement rates are already well below market
rates and are likely to get worse if no long-term fix
is enacted by Congress. But if targeted growth rates are surpassed, the IPAB
could decide to make additional cuts, further pressuring physicians to stop
seeing Medicare patients altogether.
Access to specialty care will be severely limited because of
payment cuts the IPAB will impose on physicians, particularly because the
IPAB’s authority to recommend payment cuts does not extend to other providers,
such as hospitals, until 2020.
Congress needs to repeal the IPAB before it becomes the next
SGR crisis, further risking patient access to medical care.
Dr. Valadka is a neurosurgeon from Austin, Texas, and
spokesman for the Alliance of Specialty Medicine. This article orignially appeared in CQ Roll Call.
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