January came and went with nary a whisper from the once feared but now nearly forgotten Independent Payment Advisory Board.
Enacted as part of the Affordable Care Act and originally slated to have made its first cost-cutting recommendations by now, the IPAB has no members and has never met. For 2 years in a row, Congress and the President have stripped most of the board’s funding from the federal budget.
Under the ACA, the IPAB is charged with looking at 5-year Medicare spending trends and recommending cuts for the following year if per capita spending exceeds a set target.
The IPAB’s recommendations in any given year automatically take effect if Congress does not pass legislation to achieve the savings by Aug. 15. The board cannot recommend rationing care, increasing revenues, changing benefits, modifying eligibility, increasing cost-sharing, or changing the percentage of the premium that beneficiaries pay or the subsidies they receive under Medicare Part D.
Last year, the Medicare chief actuary determined spending would stay below the 2015 target, so the IPAB did not need to act. Further, the Congressional Budget Office has estimated that continuing slow growth in health care costs could mean that the board may not be called into play for another decade.
Dr. Reid Blackwelder
Physician organizations remain interested in either repealing the board or revising its scope and composition.
The American Medical Association objects to the IPAB on principle. In Feb. 2012, AMA Executive Vice President and CEO James L. Madara wrote to congressional leaders in support of a House bill to repeal the IPAB, noting that the IPAB "puts important health care payment and policy decisions in the hands of an independent body that has far too little accountability."
For the American Academy of Family Physicians, the IPAB "just isn’t a high priority right now," Dr. Reid Blackwelder, AAFP president, said in an interview.
The AAFP is more focused on replacing the Medicare Sustainable Growth Rate formula. Should the IPAB’s work get under way, the AAFP would go back to trying to get its recommendations reconsidered, Dr. Blackwelder said.
In fact, the AAFP isn’t completely opposed to the IPAB. "We like the concept, however, we really oppose the way the IPAB was set up," Dr. Blackwelder said.
The AAFP supports several changes to the IPAB, including:
• Addition of a primary care physician and a consumer representative to the board.
• A public comment period after IPAB recommendations are sent to Congress.
• Increased focus on quality improvement.
• Inclusion of all health care sectors – not just physician fees – in the board’s immediate mandate.
While the American College of Physicians supports the general concept of an independent panel to help evaluate Medicare fiscal soundness, it wants primary care representation and equal responsibility for meeting targets among all providers.
Robert B. Doherty
Bob Doherty, senior vice president of governmental affairs and public policy at the ACP, said that he does not expect any movement from the IPAB in the near future.
"The administration has made no effort to start the appointment process, which inevitably would run into Republican resistance to recommending appointees and Republican resistance in the Senate to their confirmation," he said. Mr. Doherty noted that many Democrats don’t support the IPAB, either.
That makes the IPAB "a fight that the administration and Democrats don’t need to take on now," Mr. Doherty said.
Paul N. Van de Water, a senior fellow at the Center on Budget and Policy Priorities in Washington, predicted that while action from the IPAB is unlikely in 2014, the board eventually will be called to action.
And, Mr. Van de Water said that he thought that physicians should take a more favorable view of the IPAB. "It allows for the application of expert human judgment about how a cost growth problem should be dealt with," he said.
"It’s not an SGR, an automatic formula that you are stuck with."
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