Medicare board: Keep bureaucrats out of doctor-patient relationships

August 4, 2013 

Rep. Addia Wuchner, R-Florence, vice chair of the state House's Health and Welfare Committee, is a health care consultant, registered nurse, bioethicist and founder of Project Wings of Mercy, a group that has led international medical and humanitarian missions.

My views are shaped by more than 38 years working in health care, as a registered nurse and a vice president of strategic planning and development for a multi-hospital entity.

While medicine is clinical and science/technical, it is delivered wrapped in the art of healing and caring. Medicine's heartbeat is the relationship between patients and their practitioners, which leads to excellent outcomes. The essence of that relationship is trust, beginning with that first encounter when physicians say to their patients, "Why are you here today? How may I help you?"

As the Patient Protection and Affordable Care Act, which was signed in 2010 by President Barack Obama, takes effect, one aspect could have profound negative consequences for the physician-patient relationship. The Independent Payment Advisory Board, or IPAB, is an un-elected group of bureaucrats that could direct medical decisions, severely limit access to essential treatments and undermine quality care.

Each year, the IPAB will present Congress with recommendations for reducing Medicare spending if Medicare's actuaries estimate program spending exceeds a predetermined threshold. While reducing government spending may sound good, the devil is truly in the details.

Bottom line: IPAB has unprecedented power to impact the health care of millions of Americans. Unlike typical advisory board recommendations that have to be accepted or rejected by Congress, IPAB's recommendations become law unless Congress passes its own plan with a three-fifths majority in the Senate in relatively short order that brings comparable savings.

Considering the gridlock in Congress, I doubt any Kentucky racetrack would have enough lights on its tote board to display the long odds on Washington's ability to find such a quick compromise. An informed handicapper would wager that IPAB's decisions will stand. What will that mean?

Well, the board is charged with recommending proposals that achieve spending targets in one year. Achieving quality improvement-related cost savings in that kind of time frame is very tough. It comes as no surprise that the non-partisan Congressional Budget Office has said IPAB is likely to focus its recommendations on changes to provider payment rates. Therefore, it's safe to assume this will result in reduced care access.

The law gives the IPAB wide latitude, and, worse yet, there is no mandated role for patients in its membership. That should be chilling to everyone.

It appears IPAB's actions would intrude on and erode the physician-patient relationship, may restrict care choices and make it more difficult to access new ground-breaking treatments. Newer methods of care often bring long-term savings and improved outcomes and reduce hospitalizations and unnecessary procedures. Quality and affordability go hand-in-hand in health care, but only if they work in tandem assuring timely access and health-focused options for patients, their families and future generations.

Unfortunately, IPAB's structure only focuses on the very short-term. Such a static outlook is not helpful for improving the system and saving lives. We've achieved declining death rates for patients battling diseases such as HIV/AIDS (85 percent decline since 1995), heart disease (30 percent decline between 2001 and 2011) and cancer (20 percent decline between 1999 and 2006) by challenging status quo treatments, not settling for them.

The good news is Kentucky's U.S. senators are fighting IPAB. Sen. Mitch McConnell recently wrote to the president that he was respectfully declining to submit names of individuals to serve because "the law will give IPAB's 15 un-elected, unaccountable individuals the ability to deny seniors access to innovative care." Sen. Rand Paul is cosponsoring legislation to repeal it.

Our country needs to do more to rein in health care costs. However, the overreach potential of IPAB, its intrusion into the trusted doctor-patient relationship and dollar-driven limiting of patients' care options have the potential to decrease good health outcomes and increase the price tag for care.

Let's hope that others in Congress appreciate that, and move to fully repeal the Independent Payment Advisory Board.

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