JAC 2017: IPAB repeal, liability reform see renewed focus

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. Earlier this month, the AACU and AUA held yet another successful annual Urology Joint Advocacy Conference (JAC) in Washington. The conference featured presentations and panels on a host of pertinent urologic and advocacy-related topics, including Independent Payment Advisory Board (IPAB) repeal efforts, U.S. Preventive Services Task Force reform and access to PSA-based screening, MACRA requirements, medical liability reform, and physician burnout. A round of highly productive meetings with lawmakers on Capitol Hill capped off the meeting. Two topics of particular relevance were IPAB repeal and medical liability reform, both of which have legislative initiatives currently gaining momentum in Congress. Efforts to repeal IPAB gain steam During their meeting with lawmakers, urologists called on Congress to permanently repeal the Independent Payment Advisory Board as one of three Urology Joint Advocacy legislative priorities for 2017. Created under the Affordable Care Act as a cost control mechanism, IPAB is a 15-member panel of appointed officials who are responsible for reducing Medicare costs should they begin to rapidly rise. More specifically, if Medicare spending in a given year is expected to exceed its target growth rate, IPAB must develop and submit to Congress a proposal recommending cuts to Medicare expenses. Congress can override a submitted proposal by a supermajority, but in doing so, it must provide an alternate plan that would achieve similar cost reductions as the IPAB recommendations. Absent congressional intervention, the IPAB proposal automatically goes into effect. More from AACU: Inefficient payer approval processes fail patients, frustrate docs If triggered, IPAB would have unprecedented authority to affect massive change in the health care system despite its minimal amount of congressional oversight. But even putting aside the fundamental legal concerns, an IPAB proposal would likely make significant cuts to Medicare payments for physicians and ultimately have a devastating effect on patient access to care. Because hospitals and hospice services are exempt from IPAB recommendations until 2020-despite the fact that they account for nearly one-third of Medicare spending-IPAB cuts are likely to disproportionately fall on physicians and could in turn greatly limit the ability of urologists to treat Medicare patients. Three bills to repeal IPAB were introduced in Congress this year: H.R. 849 (introduced by Reps. Phil Roe, MD (R-TN) and Raul Ruiz, MD (D-CA), S. 251 (Democrat version introduced by Senator Ron Wyden [D-OR]), and S. 260 (Republican version introduced by Sen. John Cornyn [R-TX]). During their meetings on Capitol Hill, urologists urged lawmakers to sign on as co-sponsors to the bills, and their efforts seemed to pay off. Since March 7, S. 251 gained one new co-sponsor and S. 260 gained four, while H.R. 849 gained an impressive 41 new co-sponsors. As legislation to repeal IPAB continues to gain momentum, especially in the House, urologists must continue their advocacy efforts and reach out to Congress about this important issue. Next: Medical liability reform efforts invade D.C. Medical liability reform efforts invade D.C. Among the speakers at the JAC was Simit Pandya, government relations manager at PIAA, an insurance trade association that represents the medical liability insurance community. After describing the current liability landscape for urologists, Pandya detailed ongoing state and federal reform efforts, noting particularly the progress being made at the federal level. Significant tort reform legislation making its way through Congress has renewed efforts to change the medical liability system on a national level. Introduced by Rep. Steve King (R-IA) on Feb. 24, H.R. 1215, or the Protecting Access to Care Act of 2017, would impose a $250,000 cap on non-economic damages and a three-year statute of limitations for medical liability claims. It would also limit attorney contingency fees and implement a fair share rule that allots damages based on each defendant’s percentage of liability. Related: AUA pursues revised priorities on Capitol Hill Unlike the federal legislation that has failed in the past, the reforms in this bill apply only to those lawsuits where health care coverage was “provided or subsidized by the federal government, including through a subsidy or tax benefit,” and attempt to afford more flexibility to states. Following its recent approval by the House Judiciary Committee, the bill is expected to be considered by the entire House in the next few weeks. Despite this ongoing progress, however, the bill faces significant opposition from plaintiff’s attorneys and those who believe the legislation would trample states’ rights. As such, even if the bill does manage to pass the House, it is likely that, as Pandya predicted, the legislation will ultimately meet its demise in the Senate. 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