Monday, June 15, 2015

The Rationing Board

Six years or so ago I wrote about my objections to the ACA as then structured and subsequently jammed into law. Now, slowly but forcefully, its reality is coming to the fore. One of the messes has been PCORI, spending almost a billion a year on projects of at best questionable merit. Then the quality parade of linking the elusive quality metrics to payments. Now the Independent Payment Advisory Board. Fortunately Congress is moving to stop this. They should do the same for PCORI, ICD-10, and the mass of other excess payments. Instead the IPDB will be the de facto rationing entity denying procedures that in its opinion are not necessary.

Let me give as an example the PSA test. For most, but not all men it is not a problem. But for those for whom aggressive PCa is the case it is a sine qua non. But IPAB will deny it to all. Remember that the Government has little demonstrated competence anywhere, other than the Military.

In a recent piece in Bloomberg one of the current Administration's mouthpieces states: but forcefully

In the face of this pressure, it's crucial to move more forcefully away from fee-for-service payments and toward payments that reflect the value of care. Doing so will require a series of nimble adjustments based on evidence showing which incentives and other strategies work well. It would be foolish to bet the ranch on any one untested approach. The Independent Payment Advisory Board was created by the Affordable Care Act expressly to help with this. In particular, the IPAB is designed to provide a backstop if health costs grow beyond Congress's control. Presumably, Congress will be more likely to act if members know that failing to do so means the IPAB will step in. Those favoring repeal of the IPAB either oppose a shift away from fee-for-service payment, or believe that Congress is about to become much more adept at complicated payment reform than it has ever been in the past.

 The reality is that the IPAB can and will control treatment. Physicians will be further loaded with a new set of restrictions and more than likely lives will be lost. This was the proverbial "death panel", a name which may very well have significance.

There are many elements of the ACA worth keeping and others requiring excision. This is one which should be dead on arrival, not the patients.