First and foremost, I find the Independent Payment Advisory Board (IPAB) to be one of the most insidious elements of the Affordable Care Act (ACA). The IPAB’s sole purpose is to restrict Medicare spending; thus becoming a de facto tool for rationing. This 15-member board of unelected, and largely unaccountable, political appointees has the authority to cut billions of dollars from Medicare. And even worse, if IPAB never gets off of the ground, or fails to make any recommendations, then a single individual — the Secretary of the Department of Health and Human Services — is empowered to implement the IPAB cost-reduction plan. Fortunately, in June, the House of Representatives passed H.R. 1190, the Protecting Seniors’ Access to Medicare Act, which would repeal the IPAB. While we are on Capitol Hill, we will be urging the Senate to do the same.
Another worrisome issue is our country’s severe physician manpower shortage. Given the expansion of health insurance coverage, and as the baby boomers continue to reach retirement age, more and more Americans are seeking healthcare. Unfortunately, there aren’t enough doctors to take care of this influx of patients. According to a 2015 report by the Association of American Medical Colleges (AAMC), the United States will face an overall shortage of between 46,000-90,000 physicians by 2025. Specialty shortages will be particularly significant, including neurosurgeons, urologists, cardiologists, gastroenterologists, plastic and reconstructive surgeons, and orthopaedic surgeons. To ensure an adequate physician workforce, we are urging members of Congress to cosponsor the Resident Physician Shortage Reduction Act (H.R. 2124/S. 1148), which will support an additional 15,000 residency training positions.
Finally, I certainly can see the benefits of a national health information infrastructure and recognize the potential value of electronic health record (EHR) systems to improve the quality of patient care. However, it’s important that policymakers understand that there are considerable barriers to the widespread adoption of EHRs. These include high cost, lack of functionality (especially for specialists, which require much more tailored EHR systems), lack of relevant measures in the incentive program, and interoperability challenges. Physicians, their practices, and their EHR needs are not homogenous. Furthermore, many EHR products do not work in a way that meets my patient’s needs, and many meaningful use measures do not result in the collection of data that is important to those providing specialty care. To bring some sanity to Medicare’s currently insane EHR program, we are asking Congress to take the necessary steps to delay Stage 3 of the EHR meaningful use requirements.
In order to ensure that our patients have timely access to high-quality specialty care, the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) are joining the Alliance of Specialty Medicine, a coalition of national medical societies representing 100,000 specialty physicians, to meet with members of Congress and their staff this week to discuss these and other important health policy issues.
Alex B. Valadka, MD, is a neurosurgeon from Richmond, VA and executive board member of the American Association of Neurological Surgeons.