The re-election of President Barack Obama in early November means that the Patient Protection and Affordable Care Act will continue to take effect over the next few years, raising a number of pressing concerns for dermatology.
Healthcare was among the many issues at stake in the 2012 presidential election. The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama in 2010 and will now, with the president’s re-election, continue to roll out, with most provisions of the law expected to be in place by 2014, if not sooner.
Some provisions of the law have already been put in place, including the aspects of the law that allow young adults to stay on their parents’ healthcare plans until age 26 and that provide free preventive services for women. In 2013, states will need to make decisions about how to provide healthcare to its residents, either through in-state or federal exchanges. By 2014, the PPACA requires most people to have insurance coverage or pay a tax penalty. Other aspects of the PPACA are set to be decided even sooner, and decisions about these issues could have a significant impact for dermatology.
Pending Cuts to Medicare and Other Healthcare Avenues
As the so-called “fiscal cliff ” looms, so, too, does a potential 27% cut to Medicare physician payment. This cut would lower the income that physicians who treat Medicare payments receive.
“Sooner or later, Medicare cuts will happen,” explains Noah Scheinfeld, MD, JD, an assistant clinical professor at Columbia University. “Thirty percent of physician revenue comes from Medicare, and this will affect dermatologists who deal with a lot of skin cancer. Mohs [surgery] seems to be at least 50% Medicare patients.”
Daniel M. Siegel, MD, FAAD, the president of the American Academy of Dermatology (AAD), issued a message to members of the Academy days after the election. In his letter, Dr. Siegel ad- dresses the pending 27% cut.
“With regard to the flawed Sustainable Growth Rate (SGR), we are working with the house of medicine to help Congress determine a solution to the flawed formula that will impose a 27 percent payment cut on Jan. 1,” Dr. Siegel writes in the letter. “Recently, the AADA signed on to a letter that offers suggestions for replacing the SGR that we believe can help guide the discussion about new payment models, and ensure that we are able to continue to provide optimal care to our patients.”
In addition to the pending Medicare cut, there is also the potential for a 2% spending cut across the board to all programs.
“Congress has until Jan. 1st, 2013 to pass legislation that averts the 2% across-the-board spending cuts to all programs, known as sequestration, including funding for Medicare physician payment, medical research and Graduate Medical Education,” Dr. Siegel explains. “The Obama administration and members of Congress must now reach an agreement to come up with the necessary spending cuts and changes in fiscal policy to avert these cuts that could not only have significant economic impact, but could have negative ramifications for our healthcare system, for dermatology practices and for patient access to care.”
Jack S. Resneck, Jr, MD, an associate clinical professor of dermatology at the University of California, San Francisco (UCSF) and member of the Department of Dermatology and Institute for Health Policy Studies at UCSF, echoes Dr. Siegel’s concerns in regard to these cuts.
“The impending sequestration cuts, if allowed to occur, would do real damage to the NIH and medical research, as well as the CDC and our public health infrastructure,” Dr. Resneck explains. “Residency training programs are also facing threats; reduced federal funding for graduate medical education is being discussed as a possible component of a grand bargain on deficit reduction. At a time when a growing and aging population with expanding insurance access needs a growing physician workforce to provide care, dismantling our doctor training pipeline would be shortsighted.”
The Independent Payment Advisory Board
The PPACA calls for the establishment of an Independent Payment Advisory Board (IPAB) by 2014. The IPAB is another tool designed to limit Medicare spending and would consist of 15 members. These individuals would develop regulatory and legislative recommendations designed to slow the growth in national healthcare spending while preserving and enhancing quality of care.
“Many physician groups, while supportive of other aspects of the ACA expanding insurance cover- age, are concerned about this body,” explains Dr. Resneck. “Contrary to public understanding, IPAB is prohibited from rationing care or limiting benefits (it won’t deny care for anyone’s grandmother), but it can reduce payments to providers. Un- fortunately, it is likely to have only 2-3 physicians among its 15 members, and its recommendations can take effect without Congressional oversight, possibly limiting the input from the public and the profession that are signatures of our traditional legislative and regulatory processes. Hospitals are shielded from IPAB cuts for several years, leaving physician payments in a separate silo. Worst of all, it creates a new formula-driven mandate for payment cuts layered over the existing broken SGR system.”
Dr. Siegel echoes Dr. Resneck’s concerns.
“Much like the existing flawed Sustainable Growth Rate (SGR) formula, these target-based expenditure systems fail to contain Medicare costs and in- stead unfairly place the cost-saving bur- den on physicians,” Dr. Siegel explains. “Essentially, the IPAB would have the authority to make binding Medicare policy recommendations and non-bind- ing private payer policy recommendations to Congress, thereby granting it unprecedented power to replace congressional authority should Medicare spending exceed its estimated targets. With regard to patients, Medicare payment policy requires a broad and thorough analysis of trends in demographics, prevalence and incidence, volume and intensity of service use, and in new science, treatments and technology, among other factors. Leaving these decisions regarding payment policy in the hands of an unelected, unaccountable governmental body with minimal congressional input unintentionally would negatively impact the availability of quality, efficient healthcare to Americans.”
However, Dr. Siegel also notes that the AAD is preparing for all outcomes. “For these reasons, the AADA continues to support the repeal of the IPAB,” he says. “However, we are also working with our colleagues across the medical profession to prepare for the possibility of IPAB’s formation and to develop strategies to ensure that the perspective of physicians is represented should it move forward as envisioned in the ACA.”
Looking Ahead
Because so many of the provisions of the PPACA have yet to take effect, there is still a long waiting period to see how these issues will pan out. There are other, larger issues that are also brought to the forefront in light of so many other pending changes.
“We need metrics to grade dermatologists and show that dermatologists have an important impact on quality of life,” Dr. Scheinfeld explains, adding that a fair price for dermatologists is one of the biggest issues at stake for the specialty. “[Dermatologists] should be seen as important parts of the medical team.”
The re-election of President Barack Obama in early November means that the Patient Protection and Affordable Care Act will continue to take effect over the next few years, raising a number of pressing concerns for dermatology.
Healthcare was among the many issues at stake in the 2012 presidential election. The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama in 2010 and will now, with the president’s re-election, continue to roll out, with most provisions of the law expected to be in place by 2014, if not sooner.
Some provisions of the law have already been put in place, including the aspects of the law that allow young adults to stay on their parents’ healthcare plans until age 26 and that provide free preventive services for women. In 2013, states will need to make decisions about how to provide healthcare to its residents, either through in-state or federal exchanges. By 2014, the PPACA requires most people to have insurance coverage or pay a tax penalty. Other aspects of the PPACA are set to be decided even sooner, and decisions about these issues could have a significant impact for dermatology.
Pending Cuts to Medicare and Other Healthcare Avenues
As the so-called “fiscal cliff ” looms, so, too, does a potential 27% cut to Medicare physician payment. This cut would lower the income that physicians who treat Medicare payments receive.
“Sooner or later, Medicare cuts will happen,” explains Noah Scheinfeld, MD, JD, an assistant clinical professor at Columbia University. “Thirty percent of physician revenue comes from Medicare, and this will affect dermatologists who deal with a lot of skin cancer. Mohs [surgery] seems to be at least 50% Medicare patients.”
Daniel M. Siegel, MD, FAAD, the president of the American Academy of Dermatology (AAD), issued a message to members of the Academy days after the election. In his letter, Dr. Siegel ad- dresses the pending 27% cut.
“With regard to the flawed Sustainable Growth Rate (SGR), we are working with the house of medicine to help Congress determine a solution to the flawed formula that will impose a 27 percent payment cut on Jan. 1,” Dr. Siegel writes in the letter. “Recently, the AADA signed on to a letter that offers suggestions for replacing the SGR that we believe can help guide the discussion about new payment models, and ensure that we are able to continue to provide optimal care to our patients.”
In addition to the pending Medicare cut, there is also the potential for a 2% spending cut across the board to all programs.
“Congress has until Jan. 1st, 2013 to pass legislation that averts the 2% across-the-board spending cuts to all programs, known as sequestration, including funding for Medicare physician payment, medical research and Graduate Medical Education,” Dr. Siegel explains. “The Obama administration and members of Congress must now reach an agreement to come up with the necessary spending cuts and changes in fiscal policy to avert these cuts that could not only have significant economic impact, but could have negative ramifications for our healthcare system, for dermatology practices and for patient access to care.”
Jack S. Resneck, Jr, MD, an associate clinical professor of dermatology at the University of California, San Francisco (UCSF) and member of the Department of Dermatology and Institute for Health Policy Studies at UCSF, echoes Dr. Siegel’s concerns in regard to these cuts.
“The impending sequestration cuts, if allowed to occur, would do real damage to the NIH and medical research, as well as the CDC and our public health infrastructure,” Dr. Resneck explains. “Residency training programs are also facing threats; reduced federal funding for graduate medical education is being discussed as a possible component of a grand bargain on deficit reduction. At a time when a growing and aging population with expanding insurance access needs a growing physician workforce to provide care, dismantling our doctor training pipeline would be shortsighted.”
The Independent Payment Advisory Board
The PPACA calls for the establishment of an Independent Payment Advisory Board (IPAB) by 2014. The IPAB is another tool designed to limit Medicare spending and would consist of 15 members. These individuals would develop regulatory and legislative recommendations designed to slow the growth in national healthcare spending while preserving and enhancing quality of care.
“Many physician groups, while supportive of other aspects of the ACA expanding insurance cover- age, are concerned about this body,” explains Dr. Resneck. “Contrary to public understanding, IPAB is prohibited from rationing care or limiting benefits (it won’t deny care for anyone’s grandmother), but it can reduce payments to providers. Un- fortunately, it is likely to have only 2-3 physicians among its 15 members, and its recommendations can take effect without Congressional oversight, possibly limiting the input from the public and the profession that are signatures of our traditional legislative and regulatory processes. Hospitals are shielded from IPAB cuts for several years, leaving physician payments in a separate silo. Worst of all, it creates a new formula-driven mandate for payment cuts layered over the existing broken SGR system.”
Dr. Siegel echoes Dr. Resneck’s concerns.
“Much like the existing flawed Sustainable Growth Rate (SGR) formula, these target-based expenditure systems fail to contain Medicare costs and in- stead unfairly place the cost-saving bur- den on physicians,” Dr. Siegel explains. “Essentially, the IPAB would have the authority to make binding Medicare policy recommendations and non-bind- ing private payer policy recommendations to Congress, thereby granting it unprecedented power to replace congressional authority should Medicare spending exceed its estimated targets. With regard to patients, Medicare payment policy requires a broad and thorough analysis of trends in demographics, prevalence and incidence, volume and intensity of service use, and in new science, treatments and technology, among other factors. Leaving these decisions regarding payment policy in the hands of an unelected, unaccountable governmental body with minimal congressional input unintentionally would negatively impact the availability of quality, efficient healthcare to Americans.”
However, Dr. Siegel also notes that the AAD is preparing for all outcomes. “For these reasons, the AADA continues to support the repeal of the IPAB,” he says. “However, we are also working with our colleagues across the medical profession to prepare for the possibility of IPAB’s formation and to develop strategies to ensure that the perspective of physicians is represented should it move forward as envisioned in the ACA.”
Looking Ahead
Because so many of the provisions of the PPACA have yet to take effect, there is still a long waiting period to see how these issues will pan out. There are other, larger issues that are also brought to the forefront in light of so many other pending changes.
“We need metrics to grade dermatologists and show that dermatologists have an important impact on quality of life,” Dr. Scheinfeld explains, adding that a fair price for dermatologists is one of the biggest issues at stake for the specialty. “[Dermatologists] should be seen as important parts of the medical team.”
The re-election of President Barack Obama in early November means that the Patient Protection and Affordable Care Act will continue to take effect over the next few years, raising a number of pressing concerns for dermatology.
Healthcare was among the many issues at stake in the 2012 presidential election. The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama in 2010 and will now, with the president’s re-election, continue to roll out, with most provisions of the law expected to be in place by 2014, if not sooner.
Some provisions of the law have already been put in place, including the aspects of the law that allow young adults to stay on their parents’ healthcare plans until age 26 and that provide free preventive services for women. In 2013, states will need to make decisions about how to provide healthcare to its residents, either through in-state or federal exchanges. By 2014, the PPACA requires most people to have insurance coverage or pay a tax penalty. Other aspects of the PPACA are set to be decided even sooner, and decisions about these issues could have a significant impact for dermatology.
Pending Cuts to Medicare and Other Healthcare Avenues
As the so-called “fiscal cliff ” looms, so, too, does a potential 27% cut to Medicare physician payment. This cut would lower the income that physicians who treat Medicare payments receive.
“Sooner or later, Medicare cuts will happen,” explains Noah Scheinfeld, MD, JD, an assistant clinical professor at Columbia University. “Thirty percent of physician revenue comes from Medicare, and this will affect dermatologists who deal with a lot of skin cancer. Mohs [surgery] seems to be at least 50% Medicare patients.”
Daniel M. Siegel, MD, FAAD, the president of the American Academy of Dermatology (AAD), issued a message to members of the Academy days after the election. In his letter, Dr. Siegel ad- dresses the pending 27% cut.
“With regard to the flawed Sustainable Growth Rate (SGR), we are working with the house of medicine to help Congress determine a solution to the flawed formula that will impose a 27 percent payment cut on Jan. 1,” Dr. Siegel writes in the letter. “Recently, the AADA signed on to a letter that offers suggestions for replacing the SGR that we believe can help guide the discussion about new payment models, and ensure that we are able to continue to provide optimal care to our patients.”
In addition to the pending Medicare cut, there is also the potential for a 2% spending cut across the board to all programs.
“Congress has until Jan. 1st, 2013 to pass legislation that averts the 2% across-the-board spending cuts to all programs, known as sequestration, including funding for Medicare physician payment, medical research and Graduate Medical Education,” Dr. Siegel explains. “The Obama administration and members of Congress must now reach an agreement to come up with the necessary spending cuts and changes in fiscal policy to avert these cuts that could not only have significant economic impact, but could have negative ramifications for our healthcare system, for dermatology practices and for patient access to care.”
Jack S. Resneck, Jr, MD, an associate clinical professor of dermatology at the University of California, San Francisco (UCSF) and member of the Department of Dermatology and Institute for Health Policy Studies at UCSF, echoes Dr. Siegel’s concerns in regard to these cuts.
“The impending sequestration cuts, if allowed to occur, would do real damage to the NIH and medical research, as well as the CDC and our public health infrastructure,” Dr. Resneck explains. “Residency training programs are also facing threats; reduced federal funding for graduate medical education is being discussed as a possible component of a grand bargain on deficit reduction. At a time when a growing and aging population with expanding insurance access needs a growing physician workforce to provide care, dismantling our doctor training pipeline would be shortsighted.”
The Independent Payment Advisory Board
The PPACA calls for the establishment of an Independent Payment Advisory Board (IPAB) by 2014. The IPAB is another tool designed to limit Medicare spending and would consist of 15 members. These individuals would develop regulatory and legislative recommendations designed to slow the growth in national healthcare spending while preserving and enhancing quality of care.
“Many physician groups, while supportive of other aspects of the ACA expanding insurance cover- age, are concerned about this body,” explains Dr. Resneck. “Contrary to public understanding, IPAB is prohibited from rationing care or limiting benefits (it won’t deny care for anyone’s grandmother), but it can reduce payments to providers. Un- fortunately, it is likely to have only 2-3 physicians among its 15 members, and its recommendations can take effect without Congressional oversight, possibly limiting the input from the public and the profession that are signatures of our traditional legislative and regulatory processes. Hospitals are shielded from IPAB cuts for several years, leaving physician payments in a separate silo. Worst of all, it creates a new formula-driven mandate for payment cuts layered over the existing broken SGR system.”
Dr. Siegel echoes Dr. Resneck’s concerns.
“Much like the existing flawed Sustainable Growth Rate (SGR) formula, these target-based expenditure systems fail to contain Medicare costs and in- stead unfairly place the cost-saving bur- den on physicians,” Dr. Siegel explains. “Essentially, the IPAB would have the authority to make binding Medicare policy recommendations and non-bind- ing private payer policy recommendations to Congress, thereby granting it unprecedented power to replace congressional authority should Medicare spending exceed its estimated targets. With regard to patients, Medicare payment policy requires a broad and thorough analysis of trends in demographics, prevalence and incidence, volume and intensity of service use, and in new science, treatments and technology, among other factors. Leaving these decisions regarding payment policy in the hands of an unelected, unaccountable governmental body with minimal congressional input unintentionally would negatively impact the availability of quality, efficient healthcare to Americans.”
However, Dr. Siegel also notes that the AAD is preparing for all outcomes. “For these reasons, the AADA continues to support the repeal of the IPAB,” he says. “However, we are also working with our colleagues across the medical profession to prepare for the possibility of IPAB’s formation and to develop strategies to ensure that the perspective of physicians is represented should it move forward as envisioned in the ACA.”
Looking Ahead
Because so many of the provisions of the PPACA have yet to take effect, there is still a long waiting period to see how these issues will pan out. There are other, larger issues that are also brought to the forefront in light of so many other pending changes.
“We need metrics to grade dermatologists and show that dermatologists have an important impact on quality of life,” Dr. Scheinfeld explains, adding that a fair price for dermatologists is one of the biggest issues at stake for the specialty. “[Dermatologists] should be seen as important parts of the medical team.”
The re-election of President Barack Obama in early November means that the Patient Protection and Affordable Care Act will continue to take effect over the next few years, raising a number of pressing concerns for dermatology.
