Eyeworld

EW NEWS & OPINION 18 October 2017 Insights by J.C. Noreika, MD, MBA natural disaster relief, elected offi- cials have much time-sensitive work. There are things that you as a citizen and patient advocate can do. Call your congressman and senators. Speak to their healthcare legislative assistants. State why IPAB is a bad idea and needs to be repealed. Stress that it poses a risk to senior citizens and your patients. Next, ask for the office's scheduler. Learn when your congressman or senator will be in the neighborhood. Arrange face-to- face meetings, invite them to your practice, have lunch. Contact the ASCRS Government Relations de- partment to help and coach you. It is the rare physician who takes such initiative. "I don't have time" is too often invoked. Instead, respond to the call or email from your state's eye surgeons volun- teering their time to the ASCRS Committee of 52. Write a check to eyePAC. ASCRS Government Rela- tions will do the heavy lifting. Think of it not as a cost but an investment in family, patients, and your life's work. EW Editors' note: Dr. Noreika has practiced ophthalmology since 1981. He has been a member of ASCRS for more than 35 years. He invites you to comment on this article on the EyeWorld blog at blog.eyeworld.org. Contact information Noreika: JCNMD@aol.com Medicare & Medicaid Services use projections interpolating forecasts of the nation's GDP, Medicare per capita costs, Consumer Price Index components, and National Health Expenditure data. IPAB is granted powers histori- cally reserved for elected represen- tatives. It has been compared to the Federal Reserve Board of Governors. The ACA makes it exceedingly difficult for Congress to reject or amend IPAB's actions. The board is yet to be named, an action unlikely under the current administration. As a result, its responsibilities lie within the sole purview of the Secretary of HHS. Fortuitously, Tom Price is that person, one of only three physicians to ever lead HHS. But things will change. Cynics opine that some office- holders view the board as a means to circumvent fallout when access to doctors, technology, and drugs is restricted. If the public perceives rationing of care, politicians can say that they had nothing to do with it. And they are right. There is good news. In a rare instance of bipartisanship, Represen- tatives Dr. Phil Roe (R-TN) and Dr. Raul Ruiz (D-CA) and Senators Ron Wyden (D-OR) and John Cornyn (R- TX) have introduced bills to repeal IPAB. The bills have large co-spon- sorships and are likely to pass. But they must first come to a vote. With tax reform, government funding and cost remains tricky, unsettled, and contentious. As dissatisfaction increases, medical doctors opt for retirement or careers bereft of patient care; workforce shortages promise longer wait times for patients needing appropriate treatment. Ophthalmol- ogy, a geriatric specialty, is ground zero. A report in 2008 by the HHS Health Resources and Services Ad- ministration projected that an addi- tional 6,000 eye surgeons would be needed by 2020. Since the introduc- tion of then-unimagined treatment modalities, its estimate may prove conservative. But medical school graduates have outstripped graduate medi- cal education positions. Graduate medical education is dependent on government support and caprice. Even venerable ophthalmic institu- tions have suffered sharp reductions in their training programs. Access to care problems embolden non-phy- sician providers and stoke efforts to relax scope of practice competency. The recent optometric success in Alaska is instructive. "The passage of HB 103 is a victory for Alaskans throughout the state. HB 103 will give the Alaska Board of Examiners in Optometry the authority to write regula- tions allowing Optometrists to practice to the highest level of their education [my italics]; the current statute re- stricts Optometrists from performing procedures that they are educated to perform." Governor William Walker signed the bill into law on July 26, 2017. Organized optometry can legally determine what it can and cannot do. Another challenge, a pernicious hazard memorialized in the Afford- able Care Act (ACA), is the establish- ment of the Independent Payment Advisory Board (IPAB). During the Obamacare debate, opponents hyperbolically labeled it a death panel. The president appoints 15 board members to 6-year terms. The law stipulates that members directly involved in the provision or delivery of Medicare items and services must not constitute a voting majority. Called "unelected and unaccount- able" by House Speaker Paul Ryan, these government employees are charged with restraining Medicare cost escalation. The math is compli- cated; the Medicare Trustees Report and the actuary of the Centers for Think that physicians can't influence the historic changes being imposed upon the practice of medicine? Think again I n mid-July, the Alliance of Specialty Medicine convened a few blocks from the Capitol Rotunda. The Alliance's man- date to "protect patient access to high quality specialty care" drove the agenda. ASCRS•ASOA members composed the meeting's largest contingent. Prior to ascending the Hill, ASCRS staff provided the tools needed to meet congressmen and senators from both sides of the aisle. Rock-star speakers including ophthalmologist Senator Rand Paul and physician Congressmen Raul Ruiz and Phil Roe provided valuable insights. Secretary of Health and Human Services (HHS) Dr. Tom Price graced the podium even though the Senate was then voting on its Obamacare fix. His was a busy day. There is confusion in Washing- ton regarding the fate of America's healthcare system. Political cam- paign promises notwithstanding, the Affordable Care Act is the law of the land. As White House Deputy Chief of Staff for Legislative, Intergovern- mental Affairs, and Implementation Rick Dearborn stated, Democrats and Republicans admit its deficien- cies but can't agree "on what this country is all about." Physicians are besieged. The replacement of fee-for-service reimbursement by an evolving compensation system predicated on quality, outcomes, and the elec- tronic health record competes with perennial issues like medical liability reform. Dr. Roe sardonically joked that it was the EHR "that made me a congressman." Regulations and reporting requirements conceived by bureaucrats unaccountable to the body politic add cost and hours of uncompensated work. The pursuit of improved outcomes at lower Taking time to lead J.C. Noreika, MD, MBA

• Blank Page
• Blank Page (1)