Physician groups are rallying around a renewed effort to eliminate the Independent Payment Advisory Board. The board, part of the Patient Protection and Affordable Care Act, makes recommendations on Medicare spending.
Bipartisan legislation to repeal IPAB was introduced in the House Wednesday by Rep. Phil Roe, MD, (R-TN) and Rep. Allyson Schwartz (D-PA). It is the second attempt by the House to fold IPAB.
Jeremy Lazarus, MD, president of the American Medical Association said the AMA supports the effort to eliminate a panel it believes could wield too much power over Medicare.
"IPAB is a panel that would have too little accountability and the power to make indiscriminate cuts that would adversely affect access to healthcare for patients," he said. Lazarus added that physicians are already fending off unreasonable cuts to Medicare called for under the sustainable growth rate formula and don't need another bureaucracy overseeing it.
"Patients and physicians are still struggling with the frequent threat of drastic cuts from the broken SGR Medicare physician payment formula," said Lazarus. "IPAB would just be another arbitrary system that relies solely on payment cuts. We need to move away from these broken systems and focus on new payment and delivery models that give physicians the ability to improve patient care and reduce costs."
IPAB an "unelected, unaccountable body"
Several other physician groups weighed in on the bill, including the Congress of Neurological Surgeons and the American Association of Neurological Surgeons.
"Allowing an unelected, unaccountable body with minimal congressional oversight to have the power to make arbitrary cuts to Medicare will negatively affect timely access to quality healthcare for our patients," said John A. Wilson, MD, Washington Committee chairman for the AANS and the Congress of Neurological Surgeons.
Wilson added that the IPAB should be repealed and replaced with a "bipartisan, workable alternative that reimburses physicians effectively and safeguards access to care" for Medicare beneficiaries.
Critics also note that practicing physicians would not be eligible to serve as members of the board, an absence they contend leaves members with little insight into the needs of physicians and their patients.
In introducing the bill, Roe said that "as a physician with more than 30 years of experience, I find the ability of this board to intervene in the patient-doctor relationship particularly troubling." The bill was introduced on Jan. 23 with 83 congressional cosponsors.
Roe introduced a similar bill in 2012 that was approved by the House in a 223-181 vote but did not pass the Senate. Given that the bill was largely supported along party lines with a few exceptions, it is likely to follow a similar path in 2013.
"With Democrats still in control of the Senate, I don't see the bill being approved," said Dylan Roby, associate director of the UCLA Center for Health Policy Research in Los Angeles.
IPAB's structure and mandate
The IPAB is a 15-member board that would be tasked with controlling per capita spending on Medicare under healthcare reform. Board members are appointed by the president and, subject to Senate confirmation, and are responsible for recommending cost-cutting measures or reforms if Medicare spending exceeds predetermined limits.
Under provisions of the ACA, Medicare's top actuary is required to conduct an annual study of Medicare growth and measure it against the economy as a whole.
IPAB members are only required to make a recommendation for reforms or payment cuts when Medicare actuaries conclude that the program is growing a full percentage point faster than the rest of the economy.
Under its current schedule, IPAB would not hold its first meeting until 2014 and would not make its first recommendation until 2015, and then only if Medicare spending rates were to trigger action by the board.
IPAB supporters suggest that opponents of the board are primarily Republicans who oppose federal healthcare reform and are looking for new ways to vilify it, having already classified IPAB as a "death panel" for senior citizens.
"I don't see any merit to Republican criticism of IPAB," said Jerry Kominski, a professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health.
"The board is independent and is charged with developing and implementing policies for reducing Medicare expenditures if those expenditures are growing faster than targeted rates." He added that the "mission of IPAB is so constrained by the ACA that the only real option available is to propose eliminating coverage for ineffective healthcare services or treatments."
During a 2012 Senate hearing regarding IPAB, Sen. Jay Rockefeller (D-WV) told physicians that "lawmakers are the worst possible group to determine how you get reimbursed" and that physicians and patients would be better served by an independent board rather than a congressional committee.