Alzheimer's patients deserve repeal of payment board - Milwaukee Journal Sentinel

Wisconsin's 110,000 Alzheimer's patients and their families just received some encouraging news. According to a new study, scientists may be on the verge of creating the world's first drug for restoring nerve synapses that have been destroyed by the disease.

But as medical breakthroughs bring us closer to permanently reversing the effects of Alzheimer's, access to treatment has come under threat. A new government panel soon will have the power to make sizable Medicare cuts. If lawmakers don't scrap this board, seniors in Wisconsin and across the country will have a far harder time finding care.

The Independent Payment Advisory Board (IPAB) is one the most controversial components of the 2010 Affordable Care Act. The board's 15 presidentially appointed members are charged with enacting cuts to Medicare if that program's cost projections exceed a certain limit.

But in creating IPAB, lawmakers granted the body an alarming degree of autonomy. IPAB's cost-cutting recommendations take effect automatically and are exempt from judicial or executive review. The only way Congress can intervene is by coming up with an alternative package of money-saving ideas or mustering a super-majority to overturn the cuts.

And since IPAB is prohibited from altering Medicare's eligibility requirements, benefits, deductibles or co-payments, the board is liable to focus on reducing payments to doctors. Cuts of this sort will leave many of Wisconsin's nearly 1 million Medicare seniors unable to find a doctor.

Physicians willing to accept Medicare's already-low reimbursement rates are in short supply. An American Academy of Family Physicians ^[1] survey found that the percentage of family doctors who don't take Medicare doubled between 2004 and 2009. And according to the American Medical Association ^[2] , almost a third of primary care doctors restrict the number of elderly patients they see, mostly because of Medicare's inadequate payment rates.

On top of that, Wisconsin currently faces a serious physician shortage ^[3] . According to a Wisconsin Hospital Association ^[4] report, our state requires an additional 100 more doctors a year to meet projected demand for health care.

Even if our state meets that goal, IPAB's additional payment reductions will induce an even more severe physician shortage for Medicare patients even as the program's rolls are growing.

The threat posed by IPAB is particularly acute for Alzheimer's patients. Many of those who suffer from the illness rely on Medicare for their frequent doctor visits, as well as hospice care and prescription drugs. In fact, roughly 70% of Alzheimer's care is billed to Medicare and Medicaid. And by 2050, the incidence of the disease is expected to triple. IPAB's cuts could easily prevent future Alzheimer's patients from seeing a physician, leaving them with little hope of managing their illness.

Fortunately, the effort to repeal IPAB has garnered strong support from patient advocates and lawmakers on both sides of the aisle. Last year, the House passed an IPAB repeal bill that eventually was defeated in the Senate. But lawmakers aren't giving up.

This year, Rep. David Roe (R-Tenn.) introduced the Protecting Seniors' Access to Medicare Act, which already has more than 180 bipartisan co-sponsors, including four of Wisconsin's representatives. Passing this bill would save American seniors — especially Alzheimer's patients — years of avoidable pain and suffering.

Medicare spending must be contained, but reforms need to be implemented by elected representatives held accountable for their actions by voters. Congress has addressed Medicare growth in the past and can do so again.

The country doesn't need an unelected, unaccountable board of health care experts making life-and-death decisions about Medicare spending. What it needs are more lawmakers who are willing to do the hard work of strengthening Medicare. And the first step is repealing IPAB.

Rob Gundermann is public policy director of the Alzheimer's & Dementia Alliance of Wisconsin ^[5] .