Lee Rogers, DPM, is currently the American Diabetes Association Foot Care Council Chair. Lee's published a number of articles already in his short career and many of them on topics related to diabetic foot care or policy. He's a contributing editor to JAPMA and also an associate editor of the new Journal of Diabetic Foot Complications. He is the Associate Medical Director and co-founder of the Amputation Prevention Center at Valley Presbyterian Hospital in Los Angeles, CA. Having been a guest editor for PRESENT in the past, it is our pleasure to welcome Lee as PRESENT's new Health Policy Columnist.
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Lee C. Rogers, DPM
Associate Medical Director
Amputation Prevention Center at
Valley Presbyterian Hospital in Los Angeles, CA
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Congress hides behind new Independent Payment Advisory Board — which is likely to cut your fees further
While there are certainly good parts of the Patient Protection and Affordable Care Act (PPACA), or health reform law, like preventing insurers from excluding patients for pre-existing conditions and allowing adult children to remain on their parents insurance until age 26, there are other controversial parts. One such part is the Independent Payment Advisory Board (IPAB) made up of 15 presidential appointees, with the charge of reducing Medicare’s growth rate.
The PPACA law calls for the proposals produced by the IPAB to reduce spending to be implemented by the Secretary of Health and Human Services, unless Congress enacts separate legislation to counteract the IPAB recommendations. The proposals from the IPAB must not include rationing of healthcare, increasing premiums, restricting benefits, or changing eligibility criteria. The Board’s first recommendations will come in 2015. Hospitals will be exempt from payment modifications until 2020. This results in the brunt of cost savings falling squarely on the shoulders of physicians by implementing fee reductions. Other industries like pharmaceuticals and durable medical equipment providers would be likely to see significant reductions as well.
Currently, CMS uses the sustainable growth rate (SGR) as part of the calculation in what to reimburse providers to Medicare patients. The flaw with the SGR is that it is based on the GDP and not actual practice costs. Congressional intervention is required on a yearly, or more frequent, basis to counteract the automated reductions in physician fees. Allowing the reductions to remain would be extremely unpopular to patient and physician advocacy groups. The multiple reversals of the automated adjustments have compounded and physicians face a 29% reduction in the Medicare fee schedule on January 1, 2012. Doctors in private offices have an overhead of 50% or more, so a nearly 30% cut would come off their profit margin and really represent about a 60% pay cut.
The purpose of the IPAB may be to rid Congress of the responsibility and political liability of dealing with SGR fee changes yearly. Giving the IPAB the power to “legislate” these changes allows Congress a “hands off” approach, so that they may not be seen as culpable for the unpopular changes.
Recently in the Washington Post, George Will wrote that [the IPAB] “is a travesty of constitutional lawmaking: An executive branch agency makes laws unless Congress enacts legislation to achieve the executive agency’s aim.” read more.
The American Medical Association wrote a letter supporting the repeal of the IPAB provision of the PPACA. Bills have been introduced in the House (H.R. 452) and the Senate (S. 668) to do just that.
All parties agree that saving money where appropriate is prudent, but it needs to take into consideration the rising cost of healthcare, the increasing numbers of beneficiaries on Medicare, and the cost changes in providing healthcare. Forming an independent body appointed by the executive branch to legislate unpopular cuts for Congress is not the way.
Please be sure to share your thoughts and comments in our eTalk forum. See you next time.
Lee C. Rogers, DPM
Director of the Amputation Prevention Center
Valley Presbyterian Hospital
Los Angeles, CA
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