The U.S. Medicare payment policy requires a broad and thorough analysis regarding how it affects providers and beneficiaries. The U.S. Congress has always played an essential role in shaping policies that meet the needs of their communities and constituents to ensure the health care system is equipped to care for diverse populations of this country. Unfortunately, the Independent Payment Advisory Board (IPAB), created by the Patient Protection and Affordable Care Act (PPACA), threatens the ability of Congress to ensure access to needed health care.
Consisting of 15 members appointed solely by the President, with fewer than half being health care providers and none permitted to be otherwise employed, IPAB will be required to recommend cuts based on unrealistic spending targets starting in 2014. IPAB recommendations are “fast-tracked” and automatically go into effect starting in Fiscal Year 2015 unless blocked or amended by Congress, which would require a majority in the House and a super-majority of 60 votes in the Senate. If IPAB fails to report recommendations, the power will rest in the hands of the Secretary of the U.S. Department of Health and Human Services.
Providers representing approximately 37 percent of all Medicare payments, including hospitals and hospice care, are exempt from IPAB cuts until 2020. Initial IPAB cuts will disproportionately fall on all other providers including vascular surgeons. Furthermore, without a permanent solution to the Sustainable Growth Rate (SGR) formula, physicians are essentially subject to “double jeopardy” with cuts from both the SGR and IPAB. Not only does the creation of IPAB severely limit congressional authority, it essentially eliminates the transparency of hearings, debate and meaningful opportunity for stakeholder input.
Action on IPAB Repeal
The Society for Vascular Surgery (SVS) is committed to improving the value and cost-effectiveness of health care for Medicare beneficiaries. However, IPAB is not a suitable mechanism to achieve these goals. SVS is an active member of a coalition of 21 medical organizations, representing 400,000 physicians, that is supporting repeal of IPAB. The coalition convinced many members of the U.S. House of Representatives to become co-sponsors of the Medicare Decisions Accountability Act, H.R. 452, sponsored by Representative Roe, MD (R-TN), which repeals IPAB, with the result being a bipartisan majority of the House signing onto the bill.
After being voted out of the House Energy and Commerce and Ways and Means Committees, the House passed the bill on March 22 by a vote of 223 to 118 with 23 members not voting. In a political move, the Republican leadership attached the bill to H.R. 5 prior to the vote. This bill would establish comprehensive medical liability reform. Three amendments to the bill relating to liability reform were also approved by the House.
In the U.S. Senate, Senator Cornyn (R-TX) introduced S. 668, Health Care Bureaucrats Elimination Act, which also repeals IPAB. The bill presently has 32 Republican co-sponsors. The Senate is unlikely to take up the bill this year. IPAB was added to PPACA by the Senate Finance Committee and was supported by a majority of Senate members in 2010.