Diagnosing IPAB as a Bad Concept

Tomorrow (Wednesday, Feb. 29), the House Energy and Commerce health subcommittee is scheduled to vote on legislation that would repeal the Independent Payment Advisory Board (IPAB).  IPAB is the provision within the Affordable Care Act health reform law that empowers a 15-member board of political appointees to make recommendations to cut Medicare spending, cuts that would take effect unless Congress provides its own alternative plan.  It’s a startling transfer of authority from the legislative branch to the executive, without any judicial review to provide checks and balances.

The nation’s physicians have made it clear that they think IPAB is, to put it bluntly, a bad idea that will do more harm than good to Medicare beneficiaries.

On Monday, the American Medical Association sent a letter to the health subcommittee leadership, referring to the struggles Congress has had with the issue of Medicare payments to physicians, writing, “adding additional formulaic cuts through IPAB is just not rational and would be detrimental to patient care, especially as millions of Baby Boomers enter Medicare.”

And, prior to the AMA’s communication, a group of 24 medical specialty societies sent its own letter to the Energy and Commerce health subcommittee, sharing the concern that “the strict budgetary targets and other limits imposed on the IPAB will ultimately threaten the ability of our nation’s seniors and disabled to obtain the health care they need, when they need it.”  The specialists added, “Leaving Medicare payment decisions in the hands of an unelected, unaccountable body with minimal congressional oversight will negatively affect timely access to quality health care.”

The physicians have diagnosed the system correctly.  At a time in which Medicare needs structural reforms to continue providing quality care, but with an emphasis on value and cost-effectiveness, IPAB is a blunt instrument that will indiscriminately cut Medicare spending in a way that undermines both quality and patient access to care.

By the way, over 290 patient and health care organizations, including the Healthcare Leadership Council,  have also sent a letter to Capitol Hill urging IPAB elimination.

Let’s hope tomorrow’s subcommittee markup is the first step toward repeal of an ill-conceived idea.