Health-care reform is focused on getting better access and better care to those who need it. But one provision is positioned to do just the opposite.
Created under the Patient Protection and Affordable Care Act, the Independent Payment Advisory Board is an unelected group whose decisions could ultimately limit patients’ access to necessary treatments and undermine quality improvements in the process.
As a lupus patient, volunteer and longtime advocate, I am particularly concerned for those of us throughout Arkansas who suffer from this disease.
Lupus remains somewhat of a mystery to health-care providers, and few treatments have been developed over the last four decades. So it is vital to protect access to available therapies and reject policies that jeopardize innovative new treatments.
We are fortunate that Sen. Mark Pryor has recognized the potential negative impact of the board, and has co-sponsored legislation to repeal its authority.
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Once triggered, the advisory board could present Congress with recommendations for reducing Medicare spending by a certain designated amount if Medicare’s actuaries estimate that program spending is above a level pre-determined in law.
This may not seem like a big deal, as advisory boards make recommendations to Congress and to federal agencies all the time. However, the Independent Payment Advisory Board has been given an unprecedented amount of authority. Unlike advisory board recommendations that are reviewed, considered, then accepted or rejected, its recommendations become law unless Congress passes its own plan to achieve comparable savings with a three-fifths majority in the Senate in short order.
As we’ve seen before, that kind of quick compromising is about as likely in Washington, D.C., as snow in July.
The more likely scenario is that the board’s decisions stand. And, contrary to what some might believe, the recommended savings are unlikely to come from delivery-system reforms and patient-care improvements. That’s because the board is tasked with recommending proposals that achieve spending targets in a one-year time frame, which most experts agree is too short a window to achieve quality improvement-related cost savings.
Not only that, but hospitals, which play a significant role in determining how care is organized and delivered, are exempt from board-recommended payment cuts until 2020. As a result, the nonpartisan Congressional Budget Office has said the board is likely to focus its recommendations on changes to provider payment rates and methodologies. This could translate into less access in Medicare and higher prices for the treatments patients need for lupus and other chronic diseases.
The Independent Payment Advisory Board can make decisions that could ultimately result in some treatments or medications no longer being available. Unfortunately, new, innovative treatments-including those that are desperately needed for lupus-may be among those most likely to be affected.
What this overlooks is the downstream savings of these treatments in helping avoid hospitalizations and unnecessary procedures, not to mention the potential lives saved.
Innovative new treatments are the lifeblood of our health-care system and bring promise and hope to countless patients. Lupus patients in Arkansas and throughout the country have a lot to lose if affordable access to innovative treatments is curtailed. And yet the patient voice is conspicuously absent from the process for developing the Independent Payment Advisory Board’s proposals to Congress.
There is no question that our country needs to do more to control health-care spending. However, giving an unaccountable board the right to make changes to a program that millions of patients depend upon without congressional approval-or our input-is the wrong approach.
We thank Sen. Pryor for his leadership in supporting the repeal of the advisory board and in ensuring that all patients continue to have access to quality care and lifesaving innovations.
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Jamesetta Smith has been a volunteer in Arkansas since October 1993 when she started a support group that later became the Arkansas chapter of the Lupus Foundation of America.
Editorial, Pages 17 on 07/20/2013