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Dermatologists speak out against provisions of the Affordable Care Act


Dermatologists who strongly oppose key provisions of the Patient Protection and Affordable Care Act (ACA), upheld by the U.S. Supreme Court in late June, continue to turn their attention to Congress in the hopes of obtaining some relief.

Key Points

The ruling means that the Independent Payment Advisory Board (IPAB) will begin submitting advisory reports to Congress as early as Jan. 15, 2014, and by Jan. 15, 2015, it will deliver to Congress and the president recommendations for reducing Medicare costs. Physicians can expect to bear the brunt of those recommendations, which will be very difficult to overturn.

AADA input

"Unfortunately, the ACA missed an opportunity to permanently fix the flawed Medicare physician payment formula or enact meaningful liability reform and created the Independent Payment Advisory Board, all of which threaten to undermine access to care and destabilize healthcare delivery," Dr. Siegel said.

Asked what the AADA intends to do about the IPAB since the Supreme Court upheld the overall ACA, Dr. Siegel replied, "IPAB repeal has been a consistent priority for the AADA since the ACA's passage. The AADA's position has not changed."

Power woes

Like numerous other specialty and subspecialty organizations opposing the IPAB provision in the healthcare law, the AADA argues that it will wield far too much power, that its decisions will be extremely difficult to overturn, that its structure does not provide for sufficient physician input, and that its primary objective will be to reduce Medicare payments to physicians.

IPAB's 15 members, appointed by the president, reportedly will include experts in healthcare and the insurance industry and health economists, as well as expertise in outcomes and effectiveness research and technology assessment. Physicians will not be in the majority, and this is a major sticking point for groups such as the AADA.

The IPAB may start submitting to Congress advisory reports on matters related to Medicare as soon as Jan. 15, 2014. The annual proposals will focus on limiting Medicare spending on a per capita basis, to a fixed growth rate, initially set at a mix of general inflation in the economy and inflation in the health sector. Starting in 2018, the upper limit will be set permanently at per capita gross domestic product growth plus one percent. Hospitals are exempt from IPAB until 2019.

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