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.

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