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    Congress guts the IPAB, then takes on its role

    American Association of Clinical UrologistsBased on a partnership with Urology Times, articles from the American Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or [email protected] for more information.

    As health care economists and insurance company executives gain greater control over the provision of medical services, those who assert the sanctity of the doctor-patient relationship, including many members of Congress, accuse government and private payers of “rationing care.”

    Judging by contradictory measures approved in the waning days of 2014, lawmakers' attitudes toward that notion depend greatly on who is doing the rationing.

    RELATED - Fight or flight: Why voicing your concerns is not enough

    In a largely symbolic move, the omnibus spending bill for 2015 (aka Cromnibus) canceled a $10 million appropriation for the Independent Payment Advisory Board (IPAB). The yet-to-be-convened panel is designed to slow the growth of Medicare spending by recommending fast-tracked program cuts. Opponents, including the AACU and AUA, say the board takes power away from Congress and would lead to health care "rationing." According to The Hill, eliminating the funding "allows Republicans to attack the board without repealing it, a decision that would raise the deficit."

    On the other hand, lawmakers were quick to ration care themselves when they zeroed-out Medicare funding for vacuum erection systems (VES) to pay for a $2 billion package of tax breaks. House leadership inserted spending cuts and revenue increases into what became known as a "tax extenders" bill without subjecting those proposals to public scrutiny. Cuts included a requirement that Medicare Part B cover VES in the same manner as Medicare Part D supplies erectile dysfunction medications. Since current law prohibits Medicare Part D from covering erectile dysfunction drugs, Medicare Part B would have to follow suit by July 1, 2015. The Congressional Budget Office pegs the related savings at $400 million over 10 years.

    Medicare spending on VES has been the subject of a number of official investigations, none of which recommended the wholesale elimination of funding. Most recently, a Dec. 30, 2013 report by the U.S. Department of Health and Human Services Office of Inspector General recommended that CMS establish a special payment limit for VES or seek legislative authority to include the device in Medicare's Competitive Bidding Program. Rep. Kevin Brady (R-TX) and Sen. Claire McCaskill (D-MO) introduced legislation in their respective chambers to achieve these objectives. Neither measure moved beyond this first step in the legislative process.


    Next: Opposing rationing of care

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    • TabithaOravetz
      Regarding importance of voicing educated opinions to stand up for patients with ED and reinstating VES funding-I believe VES and ED medications should be passed out freely to all patients newly diagnosed with hypertension, diabetes, or obesity as that would probably increase medical compliance and optimally eliminate, or at a minimum, delay ED caused by 'disease processes'.