Healthcare reform law's omissions, provisions concern dermatologists

July 1, 2010

The newly passed federal healthcare legislation mandates changes that will impact dermatology practices to greater or lesser degrees, depending on practice size, patient base and other factors. But dermatologists say they're most concerned about what the legislation omits: an explanation of how the new Medicare Independent Payment Advisory Board will function, and a fix for Medicare's sustainable growth rate formula.

Key Points

EDITOR'S NOTE: How will healthcare reform affect dermatologists and their practices? In this issue, we explore some of the concerns physicians raise, including their worries about Medicare reimbursements and spending cuts. We look at new rules that will govern disclosure of corporate gifts (see "New website to disclose healthcare industry compensation") and we examine the creation of an approval pathway for follow-on biologic drugs (see "New pathway for follow-on biologics raises concerns about drug quality, prices").

National report - The newly passed federal healthcare reform legislation mandates changes that will impact dermatology practices to greater or lesser degrees, depending on practice size, patient base and other factors.

But dermatologists say they're most concerned about what the legislation omits: an explanation of how the new Medicare Independent Payment Advisory Board (IPAB) will function, and a fix for Medicare's sustainable growth rate (SGR) formula.

The Patient Protection and Affordable Care Act (PPACA), signed into law in March, and accompanying legislation establish a timeline for implementing major health-system reforms.

The new law "includes extensive changes, many of which will not be implemented for several years, for dermatologists and their patients," says William D. James, M.D., president, American Academy of Dermatology Association (AADA).

He says the AADA is providing "constructive comments" about when and how certain provisions should be implemented in an effort to "influence the pace and scope of the regulations" so that they don't undermine the physician-patient relationship or place undue burden on dermatologists.

The PPACA will extend coverage to an estimated 30 million Americans over 10 years, published accounts say. Some of these changes, such as creation of a temporary national high-risk pool for individuals with pre-existing medical conditions, take effect this year.

However, Dr. Sanchez says he doesn't "necessarily agree" with how the PPACA will be implemented.

"There's a lot of uncertainty about how the (Medicare) payments will come on. And they're not involving us physicians enough" in these decisions.

IPAB raises hackles

The most profound impact on physicians likely will come from the IPAB, Dr. Sanchez says. "The rest of the bill is fine, but this is how the money is going to be saved or distributed."

Under the PPACA, the president-appointed, 15-member IPAB must make the following Medicare spending cuts: 0.5 percent in 2015, 1.0 percent in 2016, 1.25 percent in 2017, and 1.5 percent annually in 2018 and beyond.

The American Medical Association (AMA) opposes the IPAB's current scope and authority, and the "lack of flexibility" in its mandate, stated AMA president J. James Rohack, M.D., in a May 13 AMA Health System Reform Insight.

While the PPACA represents an important step forward, he wrote in a March 25 statement, "There's more to be done to ensure access to physician care for America's patients."

Specifically, he stated, the AMA will be "relentless" in pursuing corrections to reform elements, including the IPAB.