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Federal Board Has No Place in Doctor-Patient Relationships


The American Medical Association and more than 650 other organizations support eliminating the Independent Payment Advisory Board, set up as part of Obamacare. The writer supports this position, based on her professional experience, which includes the case of a young woman dying of tuberculosis (TB).

At stake is whether healthcare at the individual level should be a government decision or a decision between doctor and patient. Of course, I believe those decisions should be left to the patient and the physician.

Saving a life

This experience dates from the time when I was an RN case manager for a health maintenance organization (HMO). I know that HMOs overall don’t have the best reputations, but good ones go to extraordinary lengths to help patients get the care they need.

This California teenager was dying. There was nothing that physicians in the area could do—we’d tried everything. National Jewish Health in Colorado has been successfully treating tuberculosis (TB) patients that other healthcare facilities couldn’t for more than 100 years, and I knew this was the teen’s only hope.

With a strong sense of determination, I made the case to my medical director that we needed to spend tens of thousands of dollars for a private medical jet to take the patient to Colorado for treatment. The director agreed, and the patient was transferred immediately.

As I like to say, the teen left California in a Lear jet and came back on a commercial airline after receiving the individualized treatment she needed to beat TB. That’s the power of individualized care plans, formulated between patient and provider and supported by the insurer.

Specter of rationing

When an entity such as the Independent Payment Advisory Board (IPAB) is involved, individual treatment goes out the window in favor cost containment. I’m all for better outcomes, but in the acute-care arena I believe that occurs by hiring more nurses and reducing nurse-to-patient ratios, not by government mandates.

What is IPAB? It was created by the Affordable Care Act (ACA) as a cost-control mechanism, but thus far it has not been activated because Medicare spending growth has not reached triggers set out in the law. That could change in 2018, and the American Medical Association (AMA) reiterated its opposition to IPAB in a July statement to the House Energy and Commerce committee. The AMA then joined 650 organizations in a joint letter to Congress calling for its demise.

When the government is involved, care costs more and is less effective. The Medicare fee-for-service payment error rate was 11% in FY 2016, an improvement over the 12.09% error rate for the previous year. But even an 11% error rates translates into more than $40 billion in improper payments. Imagine what the government could do with an extra $40 billion, maybe even return it to taxpayers like you and me. Well, probably not.

From a government perspective, the surest way to contain costs is to ration care or restrict it in some way. That’s what the United Kingdom's National Health Service is looking toward to close a £500 million budget shortfall.

In one health district trying to come up with £50 million in cuts, officials are looking at restricting the number of patients who undergo cardiac monitoring with angiograms or open up heart valves with angioplasties—despite evidence these procedures can save lives. Other possible restrictions could hit knee arthroscopy, cataract removals and tonsillectomies. Still others would limit access to hearing aids and IVF treatment, close beds in community hospitals and ration treatment to obese patients or smokers until they change their ways.

While those proposals might fly in Europe, they never will pass muster here.

You’ve probably heard the saying, “All healthcare is local." But it’s true. The best decisions are made between the patient—who knows her body and her symptoms better than anyone—and her primary care physician or specialist. The government has no business in the exam room, which is what would happen if IPAB isn’t eliminated.

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