Don’t Let A Federal Board Override the Doctor-Patient Relationship

The author encourages Congress to do away with the Independent Payment Advisory Board which will impact physicians by recommending spending cuts to Medicare
The Lund Report

OPINION – August 1, 2013 -- Imagine being told by your family doctor that the treatment she recommends is available, but not to you, because the federal government had decided its medical judgment is better than your doctor’s.

As Oregon and other states begin to implement the Affordable Care Act (ACA), known by many as Obamacare, much of the focus has been on the changes to insurance plans. Many physicians, however, are concerned about the impact of another portion of the new law known as the Independent Payment Advisory Board (IPAB).

Health care reform creates a government board called IPAB, which is a 15 member unelected board appointed by the president with minimal to no congressional oversight. It is also worth noting that members of IPAB cannot be currently practicing physicians, making it more difficult for them to stay in touch with current medical practice.

If Medicare is projected to grow too quickly, IPAB will make binding recommendations to reduce spending. Those recommendations will be sent to Capitol Hill at the beginning of the year, and if Congress doesn't like them, it must pass alternative cuts -- of the same size -- by August. A supermajority of the Senate (at least two-thirds of those present) can also vote to amend the IPAB recommendations. If Congress fails to act, the secretary of health and human services is required to implement the cuts.

During the debate about healthcare reform, politicians placed emphasis on cutting health care costs and reducing the cost to the government. To achieve this goal, the writers of the legislation included a financial tripwire that would create automatic cuts to healthcare, much like the recent sequester did with the budget. 

For physicians there are several concerns.

At the most basic level, physicians are responsible for their patients. This goes far beyond the simple issue of legal liability. We became physicians and nurses because we find caring for people a wonderful calling. We develop strong, personal relationships with those we treat. We look into the eyes of those we treat, sometimes having to deliver heart-breaking news. It is our responsibility and we don’t shy away from it.

With that responsibility, however, should be the ability to provide the treatment we feel is in the best interest for our patients. This does not mean we expect government to pay for whatever treatment we want. It does mean that we should be given the benefit of the doubt about what is best for the patients whose lives we sometimes hold in our hands.

The restrictions of IPAB are arbitrary and related to budgetary issues and not necessarily related to your healthcare.

Further, the members of IPAB are likely to cut payments to doctors for treating patients. This could also have serious impacts on the ability of patients to find access to care.  With many communities already facing doctor shortages, this will only make that problem worse.

There are better ways to keep costs low. Doctors understand the challenge and find ways to reduce the costs for our patients. Patients themselves are often good judges of what coverage they need and encourage us to find lower-cost approaches.

That’s why we are encouraging Democrats and Republicans to take a stand for their constituents and eliminate IPAB from healthcare reform. We want to thank the U.S. House of Representatives for voting to repeal the IPAB and encourage the U.S. Senate to agree to do the same.  

Physicians and patients across Oregon who have more control over their personal health choices will thank you.

Dr. Frank Palmrose is a certified anesthesiologist and is the 2013 president of the Oregon Society of Anesthesiologists. He can be reached at 

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