In the Summer 2012 issue of New Retina MD, Chief Medical Editors Jonathan L. Prenner, MD, and Richard S. Kaiser, MD, discussed the US Supreme Court's upholding of the Patient Protection and Affordable Care Act in their Editor's Message, which is reprinted here. Highlighting several key components of the legislation, Drs. Prenner and Kaiser detailed what retina specialists can expect in aftermath of this decision.

The Affordable Care Act (ACA; aka Obamacare) was upheld by the US Supreme Court this past month and may be here to stay. Many Americans believe in the principles of the legislation but find fault in the political undercurrent (or riptide) generated by it. Polls repeatedly show that a majority of Americans embrace provisions concerning coverage with preexisting conditions, allowing children to maintain insurance via their parents until age 26 and requiring corporations to provide employees with health coverage. As physicians and retina specialists, we too embrace the fundamental principle of providing health care for all Americans. But if we dig deeper into this voluminous piece of legislation, there is much more to think about.

To start, as physicians we must fight to maintain our autonomy. One of the first parts of the ACA likely to affect us is the formation of accountable care organizations (ACO). The law states that by 2012 doctors and hospitals are encouraged to legally join together and form groups that cover at least 5000 patients. These ACO's will be accountable for cost, quality and overall care. More and more doctors may relinquish their independence and join a large health care delivery system for fear of being unable to remain solvent. ACOs will surely affect primary care specialties; how they will affect subspecialties, including retina, is still very unclear. We have an important role in light of the volume of patients for whom we provide care, and we could envision retina physicians expanding and merging practices to form their own ACOs.

Another key component of the ACA that should garner our attention is the formation of an Independent Payment Advisory Board (IPAB). The Board is a 15-member government agency composed of unelected and unaccountable individuals empowered to increase Medicare savings without affecting medical coverage or the quality of delivered health care. Prior to the Affordable Care Act, MedPAC made all Medicare payment recommendations to Congress. The new system gives IPAB the power to make all changes to the Medicare program. Congress will only be able to overrule the agency's decisions only via a supermajority vote. IPAB, then, is an unelected, relatively unaccountable board, that is essentially charged with reducing Medicare spending. When Medicare spending exceeds its budget, the IPAB must put forth a proposal to reduce it without causing a loss of patient benefits. According to the Affordable Care Act, payment cuts to hospitals are offlimits until 2020 which effectively means IPAB's focus will be on reductions to physician reimbursements.

The American Medical Association (AMA) has spoken out against the IPAB, as have numerous subspecialty organizations, such as the American Academy of Orthopedic Surgery and the American Academy of Neurology, making the IPAB a primary focus of their advocacy work. Our leadership in the American Academy of Ophthalmology (AAO) is also pushing for repeal of this portion of the legislation. William Rich III, MD, the medical director of health policy for the AAO, has also spoken out against the formation of the IPAB, saying, “Hospitals are exempted despite the fact they are a bigger driver of spending than physicians. Doctors will have to pay. The whole idea of exempting hospitals, which are one of the biggest drivers of health care costs, from paying for growth that exceeds expectations after 2015 is ludicrous.” Dr. Rich surmises that the exemption “represents the power of hospitals politically.”

As retina specialists, we have an amazing group of leaders who consistently fight for the care of our patients and our field as a whole. We have been incredibly well advocated for by David W. Parke II, MD; George A. Williams, MD; Trexler M. Topping, MD; and Dr. Rich, who spend countless hours working on our behalf. However, our political strength stems in large part from our financial contributions. Now, more than ever, we need to support OphthPAC. As younger members of the retina community, we have the most to gain, but also the most to lose. It's time to write a check and make a contribution. We have a voice but it will only be heard if we show our support.

Jonathan L. Prenner, MD, is an Assistant Clinical Professor at the Retina Vitreous Center, PA, Robert Wood Johnson Medical School of the University of Medicine and Dentistry in New Brunswick, NJ. He may be reached via email at jonathanprenner@hotmail.com.

Richard S. Kaiser, MD, is an Associate Surgeon at Wills Eye Hospital, and an Associate Professor of Ophthalmology at Thomas Jefferson University Hospital in Philadelphia, and a partner in Mid Atlantic Retina. He may be reached at +1 800 331 6634; or via email at kaiserrick@aol.com.