IPAB Wields Chainsaw for Want of a Scalpel

Even if it does vote to block an IPAB recommendation, Congress will have to find other cost-cutting measures that will make the same budgetary impact as the rejected IPAB recommendations. 

Although the board does have some power to regulate healthcare costs, which almost everyone agrees are out of control, it wields a blunt instrument where a scalpel would be more appropriate.

In short, IPAB has the ability to single out Medicare reimbursement cuts, but is unable to tweak anything else. That is, the proposals made by IPAB must not include any recommendation to ration healthcare, raise revenues, or increase Medicare beneficiary premiums, increase Medicare beneficiary cost sharing (deductibles, coinsurance, or co-payments), or otherwise restrict benefits or modify eligibility criteria.

That's quite a set of restrictions on something that is intended to do what Congress seems incapable of doing—reining in Medicare spending growth. Further, as the law stands, IPAB is prevented from making cuts to hospitals and hospices until 2020, and to clinical labs until 2016.

Conversely, it can make changes to physician reimbursement as soon as it is up and running. That's why many are predicting that medical specialists will bear the most immediate burden from IPAB's reaction to out-of-control healthcare spending growth.

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