Congress guts the IPAB, then takes on its role

December 31, 2014

The 2015 omnibus spending bill canceled a $10 million appropriation for the Independent Payment Advisory Board (IPAB). Congress also approved a bill that cuts Medicare funding for vacuum erection systems. Rationing care, whether undertaken by the IPAB or Congress, must be opposed when it arbitrarily selects services based on public perception and not medical necessity, writes Ross E. Weber of the AACU.

Based on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information.

As health care economists and insurance company executives gain greater control over the provision of medical services, those who assert the sanctity of the doctor-patient relationship, including many members of Congress, accuse government and private payers of “rationing care.”

Judging by contradictory measures approved in the waning days of 2014, lawmakers' attitudes toward that notion depend greatly on who is doing the rationing.

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In a largely symbolic move, the omnibus spending bill for 2015 (aka Cromnibus) canceled a $10 million appropriation for the Independent Payment Advisory Board (IPAB). The yet-to-be-convened panel is designed to slow the growth of Medicare spending by recommending fast-tracked program cuts. Opponents, including the AACU and AUA, say the board takes power away from Congress and would lead to health care "rationing." According to The Hill, eliminating the funding "allows Republicans to attack the board without repealing it, a decision that would raise the deficit."

On the other hand, lawmakers were quick to ration care themselves when they zeroed-out Medicare funding for vacuum erection systems (VES) to pay for a $2 billion package of tax breaks. House leadership inserted spending cuts and revenue increases into what became known as a "tax extenders" bill without subjecting those proposals to public scrutiny. Cuts included a requirement that Medicare Part B cover VES in the same manner as Medicare Part D supplies erectile dysfunction medications. Since current law prohibits Medicare Part D from covering erectile dysfunction drugs, Medicare Part B would have to follow suit by July 1, 2015. The

pegs the related savings at $400 million over 10 years.

Medicare spending on VES has been the subject of a number of official investigations, none of which recommended the wholesale elimination of funding. Most recently, a Dec. 30, 2013 report by the U.S. Department of Health and Human Services Office of Inspector General recommended that CMS establish a special payment limit for VES or seek legislative authority to include the device in Medicare's Competitive Bidding Program. Rep. Kevin Brady (R-TX) and Sen. Claire McCaskill (D-MO) introduced legislation in their respective chambers to achieve these objectives. Neither measure moved beyond this first step in the legislative process.

 

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Rationing health care, whether undertaken by the 15-member IPAB or the 535-member U.S. Congress, must be opposed when that action arbitrarily selects services based on public perception and not medical necessity. Since patients who suffer from erectile dysfunction are not likely to march on Washington to demand the restoration of funding for VES, urologists and other physicians who treat diseases associated with the condition must leverage their medical training to advocate on their behalf.

The AACU has already set the wheels into motion to achieve this goal. The effort will build upon recent success in the AMA House of Delegates and give voice to tens of thousands of men who suffer from erectile dysfunction caused by disease, injury, and pharmacologic effects. Take action when called upon in the coming months and make your voice heard.

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