Letters: Proposed rehab rule would put patient care at risk

A recent article about an upcoming payment rule for inpatient rehabilitation hospitals and units, commonly referred to as IRFs, portrayed a controversial Medicare proposal to allow nonphysician practitioners (physician assistants and nurse practitioners) to perform the services currently provided by rehabilitation physicians in IRFs as a “turf war” between provider groups. However, this omits the voice of a third group with strong views on this issue—patients.

If finalized as proposed, the rule could put patients at serious risk. Patients typically arrive in IRFs in crisis, following severe illness or injury and in need of intensive rehabilitative care and medical management. They entrust their lives to IRFs to restore their health and function. Medicare patients defer to IRF providers because they assume the federal rules governing these hospitals justify their trust in their providers. This trust is violated when nonphysician practitioners replace rehabilitation physicians in making major IRF care decisions.

IRFs are not skilled-nursing facilities. They provide hospital-level care. IRFs treat some of the most complex Medicare patients, many with severe injuries or illnesses and multiple comorbidities. The rehabilitation teams in IRFs are led by highly trained physicians, typically with board certification and long-term, specialized experience in medical rehabilitation.

The patients our organizations represent have serious, often lifelong conditions such as brain injury, spinal cord injury and multiple sclerosis. IRF care can set the stage for a lifetime of health and function rather than disability. We believe rehabilitation physicians must retain the role of directing IRF care to ensure that these patients receive the expert treatment they need and deserve.

Susan H. Connors
President and CEO
Brain Injury Association of America, on behalf of the Coalition to Preserve Rehabilitation (CPR) Steering Committee

(The CPR is a coalition of 55 national organizations that represent patients—and the clinicians who serve them—in need of the intensive level of medical rehabilitation services IRFs provide.)

I support President Donald Trump’s executive order tying Medicare Part B drug pricing to the lowest price charged in “any economically comparable” developed country.

For many years I was a vice president/senior vice president with group purchasing organizations, working to bring down drug prices for large hospitals. We did so relative to what they could do on their own … but our pricing was still much higher than in other nations.

We should all support the administration’s efforts and ask that the initiative be expanded by Congress to cover all drugs. It makes absolutely no sense for U.S. citizens to be supporting drug research (through our excessively priced drugs), benefiting the entire world, including developed nations with significantly better healthcare benefits than here and lower drug pricing.

Let’s see if Congress will back Trump on a rare bipartisan basis—before he changes his mind. Already, GOP senators and representatives (beholden to Big Pharma) are saying that the bill is anti-free market.

What they won’t acknowledge is that there is currently no free market for prescription drugs. The market is heavily controlled by the government in every developed nation, including here.

In a 2017 meeting with drug company execs, Trump said, “We can increase competition and bidding wars, big time—we have to.” Yes, undoubtedly. However, we must have a truly committed president. And a Senate that is not bought off via campaign contributions.

Jack Bernard
Peachtree City, Ga.