The Independent Payment Review Board appears to be headed out of existence, much to the pleasure of much of the provider community-including urologists.
Bob GattyWashington-The Independent Payment Advisory Board (IPAB), created by the Affordable Care Act as a way to keep Medicare spending under control, appears to be headed out of existence, much to the pleasure of much of the provider community-including urologists.
Or does it?
On June 23, the House of Representatives voted to repeal the IPAB following approval of the legislation earlier in June by the House Ways and Means Committee, along with another measure scrapping the 2.3% excise tax on medical devices that was also included in the 2010 health care reform law.
The House IPAB repeal vote was originally scheduled for June 15, but that was delayed as Democrats, many of whom agree that the board should be scrapped, objected to the Republican plan to cover the cost of repeal by reducing funding for prevention and public health.
Then came a threat from the White House that President Obama would veto both IPAB repeal and the plan to eliminate the medical device tax, which is also unpopular within the health care industry-should the Senate go along with the House’s action.
The repeal of the device tax “would take away a funding source for financial assistance that is working to improve coverage and affordability and would increase the federal deficit by $24 billion over 10 years,” the White House said in a statement. The plan to ditch the tax-also approved by the House in mid-June-does not include a plan to cover that cost, unlike the IPAB repeal initiative.
The Congressional Budget Office (CBO) estimated that the IPAB repeal cost would be $7.1 billion between fiscal year 2016 and 2025. The IPAB, designed to be a 15-member independent body that would recommend cuts to the Medicare budget if program spending exceeds a target growth rate, has not even had members nominated by the president.
Medical groups, including the AUA and the American Medical Association (AMA), have been advocating repeal of the IPAB since the ACA was enacted, contending that the board would have unfettered power to slash Medicare payments without input from organized medicine.
Unlike the Medicare Payment Advisory Commission, which currently advises Congress on Medicare spending issues and makes policy recommendations that Congress may or may not accept, Congress would be required to implement the IPAB’s recommendations or develop alternatives to meet the spending target.
According to the AUA’s policy statement on the IPAB, since it may not make recommendations that would ration care, restrict benefits, change eligibility criteria or increase revenues, beneficiary premiums or cost-sharing, it would have little choice but to cut payments to providers.
“The impact this will have on beneficiaries will be reduced access to highly specialized care and innovative therapies that improve beneficiary health and quality of life,” the AUA said.
The AUA also points out that the board would be composed of “unelected, unaccountable officials” and may not include individuals directly involved in the provision or management of the delivery of Medicare items and services and could not include practicing physicians with clinical expertise.
The Alliance of Specialty Medicine, to which the AUA belongs and which represents more than a dozen other specialty and subspecialty groups, also opposes the IPAB.
“Significant health care decisions must not be made by a group of unelected, unaccountable individuals with little or no clinical expertise or the oversight required to protect access to care for America’s seniors,” the Alliance said in a statement posted on its website.
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“The Alliance is concerned that the IPAB will arbitrarily ratchet down provider reimbursement, without sufficient oversight and without care taken to ensure that Medicare beneficiaries receive the quality health care that they need and deserve.”
When the Ways and Means Committee voted 31-8 to repeal the IPAB, the AMA praised the action.
“IPAB is a flawed policy and the AMA has been advocating for the repeal of it since the ACA was passed,” said AMA President Robert Wah, MD. “It would put significant health payment and policy decisions in the hands of an independent body of individuals with far too little accountability.”
Some health care experts have pointed out that even if Congress fails to repeal IPAB, the issue is moot because the Republican-controlled Senate is not likely to confirm nominations to the board, even if qualified, willing nominees could be found.
Moreover, under the ACA, the IPAB would not be required to act unless Medicare missed its spending target. CBO projects that Medicare growth rates will remain beneath those targets until at least 2022.
However, opponents of the IPAB argue that the only way to make sure it never springs to life in a new Congress with a different political makeup is to drive a nail in its coffin now.
All of this is part of the GOP effort on Capitol Hill to knock off parts or all of the ACA and put Democratic supporters in a vulnerable position with the electorate, which Republicans view as generally “anti-Obamacare.” House Republicans have voted more than 50 times to take such action, all to no avail. Those votes have included plans to kill the entire law, kill funding, and stall implementation.
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