Some say Medicare access may soon be threatened

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Though it ensured millions of Americans now have health insurance, the Affordable Care Act did not stifle continuously skyrocketing health care costs. But one piece of the act may force drastic cuts to Medicare, and Medicare beneficiaries would ultimately pay the price, opponents say.

In all likelihood, a piece of the act called the Independent Payment Advisory Board will be triggered in the spring of 2017, experts say.

On Tuesday , a telebriefing was held to announced the creation of a coalition called "Protect My Doctor and Me," which is made up of more than 600 organizations nationwide that are urging Congress to repeal IPAB.

IPAB is put in place when Medicare growth hits a predetermined level, which is subject to change. Experts agree that IPAB will likely be triggered in 2017, and "will require approximately $1.5 billion in spending reduction," according to a Healthcare Leadership Council press release.

That means whoever is chosen to be on the board would have to make massive, sudden cuts to Medicare spending. The board would have little oversight, and its decision to make drastic cuts would not require congressional approval.

The Healthcare Leadership Council fears that, because no presidential appointees have been named to the board yet, the U.S. Secretary of Health and Human Services would be required to make Medicare cut recommendations, instead.

President-elect Donald Trump picked Georgia congressman Tom Price to be secretary of health and human services. Price is adamantly against the Affordable Care Act, having championed attempts to repeal it multiple times, and has showed interest in overhauling U.S. entitlement programs.

"IPAB is a blunt instrument intended to reduce what Medicare pays for health care services and treatment within a restricted period of time," said Mary Grealy, president of the Healthcare Leadership Council, which is part of the Protect My Doctor and Me coalition.

Grealy pointed out that those cuts would likely result in reduced access to Medicare.

Dr. Alex Valadka, chair of the Virginia Commonwealth University Department of Neurosurgery and president-elect of the American Association of Neurological Surgeons, spoke during the telebriefing about what drastic spending cuts to Medicare would mean for providers.

"Medicare does not pay providers for the full cost of caring for their patients," Valadka said, adding that Medicare pays only 80 cents on the dollar.

"When you add to that all the increasing regulatory burdens placed upon providers, it becomes overwhelming," he added.

That could mean fewer providers treat Medicare patients. And for medical schools, the burden is even greater.

"We need to find ways to generate revenue ... to teach students and residents," Valadka said. "If IPAB kicks in and limits how much we are paid ... it's going to be harder and harder to train the next generation of physicians."

During the conference, the participants spoke about changes to Medicare that they see as positive, such as MACRA legislation, or the Medicare Access and CHIP Reauthorization Act of 2015, which would, over time, convert all medical practices that receive reimbursement from Medicare or Medicaid to operate on a value-based model.

Right now many providers are paid in a fee-for-service model, which compensates them for the number of procedures or services they perform. The value-based model is meant to reward the quality of care patients receive, instead.

Physicians such as Valadka argue that value-based care is ideal, but it is a slower method and will take longer to show returns for Medicare and Medicaid than the quick cuts that IPAB would make.

"More and more, the time we take caring for patients is squeezed out by regulatory burden, and there are no signs that show that getting any easier," Valadka said.

kdemeria@timesdispatch.com(804) 649-6813Twitter: @katiedemeria