The Richmond Register


July 23, 2013

Bureaucrats shouldn’t be interfering with the doctor-patient relationship

FRANKFORT — For over 38 years, I have worked in the healthcare sector.  I have been a registered nurse and a vice president of strategic planning and development for a multiple hospital entity, and my time in both roles has helped shape my views on quality care.  While medicine is both clinical and science/technical, it is delivered wrapped in the art of healing and caring.  The heartbeat of medicine is the relationship between patients and their healthcare practitioners, which in turn leads to excellent care outcomes.  The essence of that relationship is TRUST, and it begins the moment of that first encounter when the physician says to his or her patient, “Why are you here today? How may I help you?”    

With the Patient Protection and Affordable Care Act (PPACA), the healthcare reform bill signed into law by President Obama in 2010 beginning to kick in, it’s important to take note of a particular aspect of the law that could have the most profound negative consequences for the critical trust naturally embedded in the physician-patient relationship. The Independent Payment Advisory Board, or IPAB as it is commonly called, is an unelected group of bureaucrats that could direct medical decision, severely limit patients’ access to essential treatments and may also 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 pre-determined threshold. While reducing government spending may sound good on the surface, the devil is truly in the details. 

Bottom line: IPAB has an unprecedented amount of 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 3/5 majority in the Senate in relatively short order that brings comparable savings. 

Considering the gridlock in Congress, I doubt any racetrack in Kentucky would have enough lights on their 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. But what will that mean?  

Well, the IPAB Board is charged with recommending proposals that achieve spending targets in one year. Achieving quality improvement-related cost savings in that kind of timeframe 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.  IPAB’s authority under the law gives it wide latitude, and, worse yet, patient voices will be especially absent from the process for developing IPAB’s proposals to Congress. There is no mandated role for patients in its membership. That should be chilling for everyone. 

It appears IPAB’s actions would intrude and erode the physician/patient relationship, may restrict care choices, and make it more difficult to access new, groundbreaking 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 healthcare, 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 is one that’s only focused on the very short-term. Such a static outlook is not helpful when it comes to 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 the status quo treatments, not settling for them. 

The good news is Kentucky’s two US Senators are leading the fight against IPAB. Senator 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 unelected, unaccountable individuals the ability to deny seniors access to innovative care.” Senator Rand Paul has also taken steps to stop IPAB, as he co-sponsored legislation to repeal it.

Without a doubt our country needs to do more to rein in healthcare costs. However, the overreach potential of IPAB, their intrusion into the trusted doctor-patient relationship, and dollar-driven limiting of patients’ care options has the potential over time 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. 

State Representative Addia Wuchner of Florence serves as vice chair of the Health and Welfare Committee in the Kentucky House of Representatives. She is also a healthcare consultant, registered nurse bioethicist, and the founder of Project Wings of Mercy, a group that has led medical & humanitarian aid missions across the globe.

Text Only
  • 06.29 CrystalFarewell.jpg Starting over at Head Start

    All I ever wanted to be was a journalist. Having worked on my high school and college newspapers, I knew it was the career for me.
    I love talking to people, listening to their stories, being creative every day and experiencing new things. But as you know, news happens outside the hours of 9 to 5, and my job here at the Register rarely stayed within that time frame.

    June 29, 2014 2 Photos

  • Ike Adams They don’t make strawberries as they did back in the old days

    I’m not inclined to go through my archives at the moment, but it almost feels like the column I’m about to write has almost become an annual thing over the years.
    At least I know for sure that that this is not the first time that memories of picking strawberries there on Blair Branch on hot days in June has triggered this keyboard about this time of year.
    I grew up on a little subsistence, hillside farm deep in the mountains of eastern Kentucky, among the coalfields near the Virginia line.

    June 26, 2014 1 Photo

  • Ike Adams Baby boomers have let technology rob their grandchildren of the joys of youth

    When I was growing up, it was not uncommon to see fathers and sons along creek banks fishing together or in the woods hunting squirrels or pitching horse shoes or even shooting marbles late in the afternoon in the cool hours before dark.
    Dads were teaching kids to play the games they grew up with. Little girls, learned from mothers,how to skip rope, play with jacks or play hopscotch.

    June 12, 2014 1 Photo

  • Ronnie-Ellis.jpg No Lincoln or Douglas in this debate

    Remember the famous slap-down in the 1988 vice presidential debate when Republican Dan Quayle compared his youth and limited government experience to those of John Kennedy’s when Kennedy ran for president?
    His Democratic opponent, Texas Sen. Lloyd Bentsen, acidly replied: “I knew Jack Kennedy. Jack Kennedy was a friend of mine. Senator, you’re no Jack Kennedy.”

    June 7, 2014 1 Photo

  • Ronnie-Ellis.jpg Senate campaign already in full bloom

    Any hope for a respite in the U.S. Senate campaign following Tuesday’s primary disappeared immediately.
    Mitch McConnell and Alison Lundergan Grimes came out swinging in victory speeches which sounded like campaign kickoffs.
    McConnell commended Matt Bevin on “a tough (primary) race” and appealed to Bevin supporters to unite behind his re-election bid. That will be hard for Bevin and those who backed him.

    May 24, 2014 1 Photo

  • Jim Waters.JPG ‘Taxpayer-eaters’ meet ‘self-serving politician-eaters’

    What some candidates could gain in this year’s election – beyond just winning office – is a stark reminder of how wrong political leaders were when declaring last year they had adequately addressed Kentucky’s public-pension crisis.
    Instead, legislators with serious courage deficiencies failed to agree on reforms beyond what they believe are “politically feasible.”

    May 16, 2014 1 Photo

  • Ike Adams Step Out, Step up for Diabetes Association

    Six weeks ago when I wrote here announcing the 2014 Edition of Team TKO’s American Diabetes Association, Step Out Walk Team, several dozen of you readers sent generous donations to sponsor grandson Tyler Kane Ochs (TKO) and me in the walk that takes place, rain or shine, in the mud or not, at Keeneland on the morning of May 31.
    Another several dozen of you either called, emailed or dropped a card in regular mail and asked that I remind you again “after the holidays” (Easter and Mother’s Day).

    May 16, 2014 1 Photo

  • Ronnie-Ellis.jpg Hitting the campaign trail

    The most watched race in the country ? the battle for the U.S. Senate seat now held by Republican Mitch McConnell ? has so far produced a bevy of charges and not much substance.
    We haven’t seen that much of McConnell or his likely Democratic opponent Alison Lundergan Grimes out on the campaign trail.
    McConnell’s primary opponent Matt Bevin has been much more active and visible, but his performance hasn’t enhanced his chances.

    May 11, 2014 1 Photo

  • The case of the scary black cat

    If Margie didn’t believe that black cats were the harbinger of bad luck, she certainly believed it when a black cat brushed against her leg while she was leaning over a large trash can burning garbage one late afternoon.
    Startled by the sudden appearance of the feline, Margie opened her mouth wide and let out a blood-curdling scream that could have awakened Count Dracula himself.

    May 10, 2014

  • Ike Adams Basking in the spring sunshine

    If you had asked me, as recently as two weeks ago, to make a list of things I expected to see on the first Monday in May of 2014, two of the things that I actually did see would not have been on the list, even if you’d required that it contain at least 500 items.
    I’d have been a bit skeptical about Ralph’s purple asparagus and his gorgeous snowball bush, both of which came through most admirably. And I would have had my doubts about the poppies that have been in our back yard for several generations and the bearded German Iris that Jeanette Todd gave us more than two decades ago. It faithfully stuns us there at the corner of the front porch every spring, but there they were, basking in absolute glory as the sun set Monday afternoon.

    May 8, 2014 1 Photo

AP Video
Traditional African Dishes Teach Healthy Eating The Carbon Trap: US Exports Global Warming 13 Struck by Lightning on Calif. Beach Baseball Hall of Famers Inducted Israel, Hamas Trade Fire Despite Truce in Gaza Italy's Nibali Set to Win First Tour De France Raw: Shipwrecked Concordia Completes Last Voyage Raw: Sea Turtle Hatchlings Emerge From Nest Raw: Massive Dust Storm Covers Phoenix 12-hour Cease-fire in Gaza Fighting Begins Raw: Bolivian Dancers Attempt to Break Record Raw: Israel, Palestine Supporters Rally in US Raw: Air Algerie Flight 5017 Wreckage Virginia Governor Tours Tornado Aftermath Judge Faces Heat Over Offer to Help Migrant Kids Kangaroo Goes Missing in Oklahoma More M17 Bodies Return, Sanctions on Russia Grow Raw: Deadly Tornado Hits Virginia Campground Ohio State Marching Band Chief Fired After Probe Raw: Big Rig Stuck in Illinois Swamp
Hyperlocal Search
Premier Guide
Find a business

Walking Fingers
Maps, Menus, Store hours, Coupons, and more...
Premier Guide

Should Madison County’s three local governing bodies ban smoking in indoor public places?

     View Results