Independent Payment Advisory Board
Encyclopedia
The Independent Payment Advisory Board, or IPAB, is a fifteen-member, unelected United States Government
agency
created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act
which has the explicit task of reducing the rate of growth in Medicare without affecting coverage or quality. Under previous law, changes to Medicare reimbursement rates were recommended by MedPAC but required an act of congress to take effect, but the new system devolves responsibility to IPAB with the Congress being given the power to overrule the agency's decisions.
The Board is required to implement its first proposals in 2015 with its first report being produced by July 2014. The Chief Actuary of the Centers for Medicare and Medicaid Services
will determine in particular years the projected per capita
growth rate for Medicare for the second year thereafter. If the projection exceeds a target growth rate, IPAB must develop a proposal to reduce per capita Medicare spending. The Secretary of Health and Human Services
must then implement the proposal unless Congress
enacts resolutions made to override the Board's decisions under a fast-track procedure that the law sets forth.
(MedPAC), a body with no regulatory power that solely advises Congress, but can not enact regulations in and of itself. Since 1997, MedPAC had recommended cuts totaling "hundreds of billions of dollars" to Medicare that were ignored by Congress. Also, Congress has pressured Medicare administrators to cover "ineffective or needlessly costly methods of care", while Medicare's founding legislation says "Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine". Henry J. Aaron, a health care expert at the Brookings Institution
, says that many observers see that some in Congress are "in thrall to campaign contributors and producers and suppliers of medical services" and most are not well enough informed to wisely use Medicare's buying power to reform health care. The idea behind the IPAB was to take power away from Congress (and special interests) in order to give it to those knowledgeable in health care policy.
introduced the Medicare Payment Advisory Commission Reform Act of 2009, which would have changed MedPAC into an executive branch agency. On July 17, 2009, the Obama administration submitted to Congress a similar proposal called the Independent Medicare Advisory Council Act, which would have created an independent five-member executive council to make recommendations to the president. From June 17 to September 14, 2009, three Democratic and three Republican Senate Finance Committee
members met for a series of thirty one meetings to discuss the development of a health care reform bill. During this period, Senators Max Baucus
(D-Montana), Chuck Grassley
(R-Iowa), Kent Conrad
(D-North Dakota), Olympia Snowe
(R-Maine), Jeff Bingaman
(D-New Mexico), and Mike Enzi
(R-Wyoming), met for more than sixty hours, and their discussions established the principles upon which the health care reform legislation that later passed was based. The Finance Committee included a provision establishing an independent Medicare advisory board in its health reform legislation, which passed the Senate on December 24, 2009.
According to official records, the proposals made by IPAB should not include any recommendation to ration health care, 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. The Department of Health and Human Services (HHS) must implement these proposals unless Congress adopts equally effective alternatives. The board is also required to submit to Congress annual reports on health care costs, access, quality, and utilization. IPAB must submit to Congress recommendations on how to slow the growth in total private health care expenditures.
Every year on September 1, IPAB must submit a draft proposal to the Secretary of Health and Human Services. On January 15 of the next year IPAB must submit a proposal to Congress. If IPAB fails to meet this deadline, the HHS must create its own proposal. Congress must consider this proposal under special rules. Congress cannot consider any amendment to the proposal that does not achieve similar cost reductions unless both houses of Congress, including a three-fifths super majority in the Senate, vote to waive this requirement. If Congress fails to adopt a substitute provision by August 15, HHS must implement the proposal as originally submitted to Congress.
With regard to IPAB's recommendations, the law says "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and co-payments), or otherwise restrict benefits or modify eligibility criteria."
, durable medical equipment, ambulance services, and services of ambulatory surgical centers".
The IPAB "will probably increase the pressure" on health care provider
s to coordinate care and form accountable care organization
s.
, subject to Senate confirmation
. The Secretary of HHS, the Administrator of the Center for Medicare and Medicaid Services, and the Administrator of the Health Resources and Services Administration
serve ex officio as nonvoting members. In making the appointments, the President consults with the Majority Leader of the Senate
concerning the appointment of three members; the Speaker of the House of Representatives
concerning the appointment of three members, the Minority Leader of the Senate
concerning the appointment of three members, and the Minority Leader of the House of Representatives
concerning the appointment of three members.
The first members appointed to the Board will be divided into three staggered classes in order to ensure that their terms do not expire simultaneously. Five will be appointed for a term of one year, five will be appointed for a term of three years, and five will be appointed for a term of six years. All subsequent appointments will be made for six years. A member may not serve more than two full consecutive terms. Individuals who are directly involved in providing or managing the delivery of Medicare items and services may not constitute a majority of IPAB’s membership.
The President of the United States must establish a system
for public disclosure
by IPAB members of any financial and other potential conflicts of interest. As it currently stands, no IPAB member may be engaged in any other business, vocation or employment.
Members will be paid at a rate described in Level III of the Executive Schedule
that determines pay for senior executive branch officials. As of 2010 this is $165,300 per year.
thinks that given the "dubious style of campaign financing
of which we all are victims now", an independent Medicare commission is the U.S.'s only hope to restrain Medicare spending. Reinhardt criticized former chairman of the House Ways and Means Subcommittee on Health
William Thomas' 1995 comment as emblematic of the spurious reasoning found in Congress. Of a payment system that resembled bundled payment
, Thomas said, "I'm not wild about a payment system that involves telling a bunch of innovative entrepreneurs that they can’t be in the business anymore". Reinhardt criticized this, saying Thomas "seemed uninterested in what made more clinical and economic sense. His was purely an industrial policy
, not a health policy. And his reasoning explains why, year in year out, Congress has rejected economically sensible proposals to attain greater efficiency in the Medicare program." Reinhardt compares the IPAB to a similar board in Germany, which he says is efficient, effective and civilized.
, who directed the CBO and OMB in the Obama administration, said the IPAB may be the most important aspect of the Affordable Care Act. He said the board was "created to help address our long-term fiscal imbalance while boosting quality in health care". "It's a very promising structure," said Orszag, but he cautioned that "whether it realizes its potential depends on how it's implemented."
Douglas Holtz-Eakin
, a former CBO director and an economist who is currently president of a conservative political organization
, thinks that despite "requirements that would force Congress to adopt the recommendations or find comparable savings", "cuts will be politically infeasible, as Congress is likely to continue regularly to override scheduled reductions". In the words of Susan Dentzer
, editor of Health Affairs
, Holtz-Eakin thinks no IPAB "will ever succeed in saving lawmakers from their own self-preserving instincts to pander".
, a Republican from Texas, introduced a bill in the Senate to prevent the creation of the IPAB. The Washington Post
reported that Congressman and retired physician Phil Roe
(R-TN) twice sponsored House bills to eliminate the IPAB, which was partially why he was regarded as a "kindred soul" by the medical industry. Roe was described as a "magnet during the last election for more than $90,000 in contributions from medical professionals from across the country" Roe charged that IPAB would deny care. However, the legislation governing IPAB bars "any recommendation to ration health care."
Tom Daschle
, the former Senate Democratic leader who was Obama's first choice for health secretary, argues that IPAB should be expanded to cover all forms of health insurance in order to prevent doctors from shifting costs onto patients with private medical insurance. After voting for the 2010 health care reform, Pete Stark
(D-Calif.), said that the IPAB "sets [Medicare] up for unsustainable cuts" that will endanger the health of patients, and that he would "work tirelessly to mitigate the damage" the panel would cause.
has said that elimination of the payment board is its top priority in the 2011 Congress. The American Hospital Association
and the American Medical Association
(AMA) have spoken out against the board. The AMA wants to change the IPAB requirement that members have no outside employment so working physicians can be considered. The AMA also opposes any independent commission which could cut physician payment rates.
Dr. J. Fred Ralston Jr., president of the American College of Physicians
(ACP), expressed support for the idea behind the IPAB, saying "making complex Medicare payment and budgetary decisions is very difficult within a political process with substantial lobbying pressures", but the group would like to see significant changes. The ACP supports creating a position for a primary care physician on IPAB, additional protections that ensure cost reductions do not lead to lower quality of care, authority for Congress to reject proposals made by IPAB via a simple majority vote, and equal treatment of all healthcare providers.
Dr. Elaine C. Jones, government relations committee cochair of the American Academy of Neurology
stated, "We are also very concerned about the power of the IPAB to cut payments to physicians. The sole function of the IPAB is to cut spending with little guarantee of maintaining quality, access, and scientifically proven care. There may be no physician representation on the board either. These elements are concerning and unacceptable."
Ron Pollack, the founding executive director of the health care advocacy group Families USA
, advised Democrats against being divided and conquered by supporting repeal of specific portions of the health care reform, such as IPAB.
Two major nursing home associations, the American Health Care Association
and the American Association of Homes and Services for the Aging, along with seventy two other healthcare groups, urged Congress to reject IPAB. They argued that the board would have too much control over Medicare and would affect the ability of healthcare providers to lobby for changes in how they are reimbursed. The groups also argued that IPAB would only be accountable to the president.
The American Academy of Orthopedic Surgeons
has made IPAB a focus of their advocacy work. Hospital exemptions from 2015 to 2020 as well as the lack of practicing physicians on the board itself are major concerns. Recent lobbying efforts in April of 2011 have focused on making these modifications if not fully eliminating this board.
(CBO) estimated that IPAB will achieve Medicare spending reductions of twenty eight billion through 2019—amounting to 0.04% of the projected Medicare spending of ~$7 trillion for the period.
In March 2011, the CBO estimated the Medicare baseline level of spending would not exceed targets throughout the years of 2015 to 2021; thus, the IPAB was not expected to affect any Medicare spending.
, issued a report on reducing the federal deficit and voted to strengthen the IPAB 11 to 7. It wished to bring forward the time by which health care providers would be affected by IPAB decisions. The recommendations "would hit hospitals the hardest, which gained an exemption from the group’s decisions for several years".
, along with three Republican congressman from Arizona, filed a suit challenging the constitutionality of the IPAB. The Hill reported that "while the suit illustrates conservative frustration with the federal government, the courts rarely strike down advisory boards created by Congress".
Federal government of the United States
The federal government of the United States is the national government of the constitutional republic of fifty states that is the United States of America. The federal government comprises three distinct branches of government: a legislative, an executive and a judiciary. These branches and...
agency
Government agency
A government or state agency is a permanent or semi-permanent organization in the machinery of government that is responsible for the oversight and administration of specific functions, such as an intelligence agency. There is a notable variety of agency types...
created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act
Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law is the principal health care reform legislation of the 111th United States Congress...
which has the explicit task of reducing the rate of growth in Medicare without affecting coverage or quality. Under previous law, changes to Medicare reimbursement rates were recommended by MedPAC but required an act of congress to take effect, but the new system devolves responsibility to IPAB with the Congress being given the power to overrule the agency's decisions.
The Board is required to implement its first proposals in 2015 with its first report being produced by July 2014. The Chief Actuary of the Centers for Medicare and Medicaid Services
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
will determine in particular years the projected per capita
Per capita
Per capita is a Latin prepositional phrase: per and capita . The phrase thus means "by heads" or "for each head", i.e. per individual or per person...
growth rate for Medicare for the second year thereafter. If the projection exceeds a target growth rate, IPAB must develop a proposal to reduce per capita Medicare spending. The Secretary of Health and Human Services
United States Secretary of Health and Human Services
The United States Secretary of Health and Human Services is the head of the United States Department of Health and Human Services, concerned with health matters. The Secretary is a member of the President's Cabinet...
must then implement the proposal unless Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
enacts resolutions made to override the Board's decisions under a fast-track procedure that the law sets forth.
Background
IPAB was created as a strengthened version of the Medicare Payment Advisory CommissionMedicare Payment Advisory Commission
The Medicare Payment Advisory Commission is an independent US federal body. MedPAC was established by the Balanced Budget Act of 1997 . Its primary role is to advise the US Congress on issues affecting the administration of the Medicare program...
(MedPAC), a body with no regulatory power that solely advises Congress, but can not enact regulations in and of itself. Since 1997, MedPAC had recommended cuts totaling "hundreds of billions of dollars" to Medicare that were ignored by Congress. Also, Congress has pressured Medicare administrators to cover "ineffective or needlessly costly methods of care", while Medicare's founding legislation says "Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine". Henry J. Aaron, a health care expert at the Brookings Institution
Brookings Institution
The Brookings Institution is a nonprofit public policy organization based in Washington, D.C., in the United States. One of Washington's oldest think tanks, Brookings conducts research and education in the social sciences, primarily in economics, metropolitan policy, governance, foreign policy, and...
, says that many observers see that some in Congress are "in thrall to campaign contributors and producers and suppliers of medical services" and most are not well enough informed to wisely use Medicare's buying power to reform health care. The idea behind the IPAB was to take power away from Congress (and special interests) in order to give it to those knowledgeable in health care policy.
Legislative history
On June 25, 2009, Senator Jay RockefellerJay Rockefeller
John Davison "Jay" Rockefeller IV is the senior United States Senator from West Virginia. He was first elected to the Senate in 1984, while in office as Governor of West Virginia, a position he held from 1977 to 1985...
introduced the Medicare Payment Advisory Commission Reform Act of 2009, which would have changed MedPAC into an executive branch agency. On July 17, 2009, the Obama administration submitted to Congress a similar proposal called the Independent Medicare Advisory Council Act, which would have created an independent five-member executive council to make recommendations to the president. From June 17 to September 14, 2009, three Democratic and three Republican Senate Finance Committee
United States Senate Committee on Finance
The U.S. Senate Committee on Finance is a standing committee of the United States Senate. The Committee concerns itself with matters relating to taxation and other revenue measures generally, and those relating to the insular possessions; bonded debt of the United States; customs, collection...
members met for a series of thirty one meetings to discuss the development of a health care reform bill. During this period, Senators Max Baucus
Max Baucus
Max Sieben Baucus is the senior United States Senator from Montana and a member of the Democratic Party. First elected to the Senate in 1978, as of 2010 he is the longest-serving Senator from Montana, and the fifth longest-serving U.S...
(D-Montana), Chuck Grassley
Chuck Grassley
Charles Ernest "Chuck" Grassley is the senior United States Senator from Iowa . A member of Republican Party, he previously served in the served in the United States House of Representatives and the Iowa state legislature...
(R-Iowa), Kent Conrad
Kent Conrad
Kent Conrad is the senior United States Senator from North Dakota. He is a member of the North Dakota Democratic-NPL Party, the North Dakota affiliate of the Democratic Party...
(D-North Dakota), Olympia Snowe
Olympia Snowe
Olympia Jean Snowe , née Bouchles, is the senior United States Senator from Maine and a member of the Republican Party. Snowe has become widely known for her ability to influence the outcome of close votes, including whether to end filibusters. She and her fellow Senator from Maine, Susan Collins,...
(R-Maine), Jeff Bingaman
Jeff Bingaman
Jesse Francis "Jeff" Bingaman, Jr. , is the senior U.S. Senator from New Mexico and a member of the Democratic Party...
(D-New Mexico), and Mike Enzi
Mike Enzi
Michael Bradley "Mike" Enzi is the senior U.S. Senator from Wyoming and a member of the Republican Party.Raised in Thermopolis, Wyoming, Enzi attended George Washington University and the University of Denver. He expanded his father's shoe store business in Gillette before being elected mayor of...
(R-Wyoming), met for more than sixty hours, and their discussions established the principles upon which the health care reform legislation that later passed was based. The Finance Committee included a provision establishing an independent Medicare advisory board in its health reform legislation, which passed the Senate on December 24, 2009.
Mission
IPAB is tasked with developing specific proposals to bring the net growth in Medicare spending back to target levels if the Medicare Actuary determines that net spending is forecast to exceed target levels, beginning in 2015.According to official records, the proposals made by IPAB should not include any recommendation to ration health care, 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. The Department of Health and Human Services (HHS) must implement these proposals unless Congress adopts equally effective alternatives. The board is also required to submit to Congress annual reports on health care costs, access, quality, and utilization. IPAB must submit to Congress recommendations on how to slow the growth in total private health care expenditures.
Every year on September 1, IPAB must submit a draft proposal to the Secretary of Health and Human Services. On January 15 of the next year IPAB must submit a proposal to Congress. If IPAB fails to meet this deadline, the HHS must create its own proposal. Congress must consider this proposal under special rules. Congress cannot consider any amendment to the proposal that does not achieve similar cost reductions unless both houses of Congress, including a three-fifths super majority in the Senate, vote to waive this requirement. If Congress fails to adopt a substitute provision by August 15, HHS must implement the proposal as originally submitted to Congress.
With regard to IPAB's recommendations, the law says "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and co-payments), or otherwise restrict benefits or modify eligibility criteria."
Predicted outcomes
A 2009 Kaiser Health News article predicted primary care doctors would likely see benefits from an "independent Medicare commission because the panel would be more likely to increase their fees and lower specialists' rates". While payment cuts to hospitals and hospices are off-limits until 2020, and clinical laboratories are off limits until 2016, physician fees may be cut unless a doc fix to Medicare's sustainable growth rate formula makes those cuts off limits. Other "savings would have to be found in private Medicare Advantage plans, Medicare’s Part D prescription-drug program, or spending on skilled-nursing facilities, home-based health care, dialysisDialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
, durable medical equipment, ambulance services, and services of ambulatory surgical centers".
The IPAB "will probably increase the pressure" on health care provider
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
s to coordinate care and form accountable care organization
Accountable care organization
An accountable care organization is a type of payment and delivery reform model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an ACO, which then...
s.
Membership and term of office
IPAB is composed of fifteen members appointed by the PresidentPresident of the United States
The President of the United States of America is the head of state and head of government of the United States. The president leads the executive branch of the federal government and is the commander-in-chief of the United States Armed Forces....
, subject to Senate confirmation
Advice and consent
Advice and consent is an English phrase frequently used in enacting formulae of bills and in other legal or constitutional contexts, describing a situation in which the executive branch of a government enacts something previously approved of by the legislative branch.-General:The expression is...
. The Secretary of HHS, the Administrator of the Center for Medicare and Medicaid Services, and the Administrator of the Health Resources and Services Administration
Health Resources and Services Administration
The Health Resources and Services Administration , is an agency of the U.S. Department of Health and Human Services located in Rockville, Maryland...
serve ex officio as nonvoting members. In making the appointments, the President consults with the Majority Leader of the Senate
Party leaders of the United States Senate
The Senate Majority and Minority Leaders are two United States Senators who are elected by the party conferences that hold the majority and the minority respectively. These leaders serve as the chief Senate spokespeople for their parties and manage and schedule the legislative and executive...
concerning the appointment of three members; the Speaker of the House of Representatives
Speaker of the United States House of Representatives
The Speaker of the United States House of Representatives, or Speaker of the House, is the presiding officer of the United States House of Representatives...
concerning the appointment of three members, the Minority Leader of the Senate
Party leaders of the United States Senate
The Senate Majority and Minority Leaders are two United States Senators who are elected by the party conferences that hold the majority and the minority respectively. These leaders serve as the chief Senate spokespeople for their parties and manage and schedule the legislative and executive...
concerning the appointment of three members, and the Minority Leader of the House of Representatives
Minority leader of the United States House of Representatives
The House Minority Leader is one of the party leaders of the United States House of Representatives. This title is currently held by Democratic Representative Nancy Pelosi of California....
concerning the appointment of three members.
The first members appointed to the Board will be divided into three staggered classes in order to ensure that their terms do not expire simultaneously. Five will be appointed for a term of one year, five will be appointed for a term of three years, and five will be appointed for a term of six years. All subsequent appointments will be made for six years. A member may not serve more than two full consecutive terms. Individuals who are directly involved in providing or managing the delivery of Medicare items and services may not constitute a majority of IPAB’s membership.
The President of the United States must establish a system
Executive order
An executive order in the United States is an order issued by the President, the head of the executive branch of the federal government. In other countries, similar edicts may be known as decrees, or orders in council. Executive orders may also be issued at the state level by a state's governor or...
for public disclosure
Freedom of information
Freedom of information refers to the protection of the right to freedom of expression with regards to the Internet and information technology . Freedom of information may also concern censorship in an information technology context, i.e...
by IPAB members of any financial and other potential conflicts of interest. As it currently stands, no IPAB member may be engaged in any other business, vocation or employment.
Members will be paid at a rate described in Level III of the Executive Schedule
Executive Schedule
Executive Schedule refers to the highest-ranked appointed positions in the executive branch of the U.S. government. The President of the United States, an elected official, appoints incumbents to these positions, most of them with the advice and consent of the Senate. They include members of the...
that determines pay for senior executive branch officials. As of 2010 this is $165,300 per year.
Funding
Fifteen million dollars have been appropriated for IPAB in 2012. Future funding for the agency will be based on this figure but adjusted for inflation.Experts
Health economist Uwe ReinhardtUwe Reinhardt
Uwe E. Reinhardt is a professor of political economy at Princeton University and holds several positions in the healthcare industry. Reinhardt is a prominent scholar in health care economics and a frequent speaker and author on subjects ranging from the war in Iraq to the future of Medicare.-...
thinks that given the "dubious style of campaign financing
Campaign finance in the United States
Campaign finance in the United States is the financing of electoral campaigns at the federal, state, and local levels.At the federal level, the primary source of campaign funds is individuals; political action committees are a distant second. Contributions from both are limited, and direct...
of which we all are victims now", an independent Medicare commission is the U.S.'s only hope to restrain Medicare spending. Reinhardt criticized former chairman of the House Ways and Means Subcommittee on Health
United States House Ways and Means Subcommittee on Health
The U.S. House Energy Subcommittee on Health is a subcommittee within the House Committee on Energy and Commerce.-Jurisdiction:The House Subcommittee on Health has general jurisdiction over bills and resolutions relating to issues within the scope of the Subcommittee's jurisdiction, and has...
William Thomas' 1995 comment as emblematic of the spurious reasoning found in Congress. Of a payment system that resembled bundled payment
Bundled payment
Bundled payment, also known as episode-based payment, episode payment, episode-of-care payment, case rate, evidence-based case rate, global bundled payment, global payment, package pricing, or packaged pricing, is defined as the reimbursement of health care providers "on the basis of expected...
, Thomas said, "I'm not wild about a payment system that involves telling a bunch of innovative entrepreneurs that they can’t be in the business anymore". Reinhardt criticized this, saying Thomas "seemed uninterested in what made more clinical and economic sense. His was purely an industrial policy
Industrial policy
The Industrial Policy plan of a nation, sometimes shortened IP, "denotes a nation's declared, official, total strategic effort to influence sectoral development and, thus, national industry portfolio." These interventionist measures comprise "policies that stimulate specific activities and promote...
, not a health policy. And his reasoning explains why, year in year out, Congress has rejected economically sensible proposals to attain greater efficiency in the Medicare program." Reinhardt compares the IPAB to a similar board in Germany, which he says is efficient, effective and civilized.
Former CBO directors
Peter OrszagPeter Ország
Peter Ország is a Slovak ice hockey referee, who referees in the Slovak Extraliga.-Career:He has officiated many international tournaments including the Winter Olympics. He has been named Slovak referee of the year....
, who directed the CBO and OMB in the Obama administration, said the IPAB may be the most important aspect of the Affordable Care Act. He said the board was "created to help address our long-term fiscal imbalance while boosting quality in health care". "It's a very promising structure," said Orszag, but he cautioned that "whether it realizes its potential depends on how it's implemented."
Douglas Holtz-Eakin
Douglas Holtz-Eakin
Douglas J. "Doug" Holtz-Eakin is an American economist, former professor, former Director of the Congressional Budget Office and former chief economic policy adviser to U.S...
, a former CBO director and an economist who is currently president of a conservative political organization
American Action Network
American Action Network is a 501 issue advocacy organization that focuses on promoting what it styles as “center-right policies.” It was established in February 2010 by Douglas Holtz-Eakin, a former adviser to the presidential campaign of Senator John McCain, and former Republican Senator from...
, thinks that despite "requirements that would force Congress to adopt the recommendations or find comparable savings", "cuts will be politically infeasible, as Congress is likely to continue regularly to override scheduled reductions". In the words of Susan Dentzer
Susan Dentzer
Susan Dentzer is the editor-in-chief of the academic journal Health Affairs. She is a member of the Institute of Medicine and the Council on Foreign Relations, the former health correspondent for the News Hour with Jim Lehrer, and a fellow at the Hastings Center. She is a graduate of Dartmouth...
, editor of Health Affairs
Health Affairs
Health Affairs is a peer-reviewed healthcare journal established in 1981 by John K. Iglehart. It was described by The Washington Post as "the bible of health policy". Health Affairs is indexed and/or abstracted in PubMed, MEDLINE, EBSCO databases, ProQuest, LexisNexis, Current Contents/Health...
, Holtz-Eakin thinks no IPAB "will ever succeed in saving lawmakers from their own self-preserving instincts to pander".
Politicians
Sen. John CornynJohn Cornyn
John Cornyn, III is the junior United States Senator for Texas, serving since 2003. He is a member of the Republican Party. He was elected Chairman of the National Republican Senatorial Committee for the 111th U.S. Congress....
, a Republican from Texas, introduced a bill in the Senate to prevent the creation of the IPAB. The Washington Post
The Washington Post
The Washington Post is Washington, D.C.'s largest newspaper and its oldest still-existing paper, founded in 1877. Located in the capital of the United States, The Post has a particular emphasis on national politics. D.C., Maryland, and Virginia editions are printed for daily circulation...
reported that Congressman and retired physician Phil Roe
Phil Roe
David Phillip "Phil" Roe is the U.S. Representative for , serving since 2009. He is a member of the Republican Party. The district is based in the Tri-Cities area in the northeastern portion of the state....
(R-TN) twice sponsored House bills to eliminate the IPAB, which was partially why he was regarded as a "kindred soul" by the medical industry. Roe was described as a "magnet during the last election for more than $90,000 in contributions from medical professionals from across the country" Roe charged that IPAB would deny care. However, the legislation governing IPAB bars "any recommendation to ration health care."
Tom Daschle
Tom Daschle
Thomas Andrew "Tom" Daschle is a former U.S. Senator from South Dakota and former U.S. Senate Majority Leader. He is a member of the Democratic Party....
, the former Senate Democratic leader who was Obama's first choice for health secretary, argues that IPAB should be expanded to cover all forms of health insurance in order to prevent doctors from shifting costs onto patients with private medical insurance. After voting for the 2010 health care reform, Pete Stark
Pete Stark
Fortney Hillman "Pete" Stark, Jr. is the U.S. Representative for , serving since 1973. He is a member of the Democratic Party. Currently he is the 5th most senior Representative, as well as 6th most senior member of Congress overall...
(D-Calif.), said that the IPAB "sets [Medicare] up for unsustainable cuts" that will endanger the health of patients, and that he would "work tirelessly to mitigate the damage" the panel would cause.
Lobbying groups
The Pharmaceutical Research and Manufacturers of AmericaPharmaceutical Research and Manufacturers of America
Pharmaceutical Research and Manufacturers of America , founded in 1958, is a trade group representing the pharmaceutical research and biopharmaceutical companies in the United States. PhRMA's stated mission is advocacy for public policies that encourage the discovery of new medicines for patients...
has said that elimination of the payment board is its top priority in the 2011 Congress. The American Hospital Association
American Hospital Association
The American Hospital Association is an organization that promotes the quality provision of health care by hospitals and health care networks through such efforts as promoting effective public policy and providing information related to health care and health administration to health care...
and the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
(AMA) have spoken out against the board. The AMA wants to change the IPAB requirement that members have no outside employment so working physicians can be considered. The AMA also opposes any independent commission which could cut physician payment rates.
Dr. J. Fred Ralston Jr., president of the American College of Physicians
American College of Physicians
The American College of Physicians is a national organization of doctors of internal medicine —physicians who specialize in the prevention, detection, and treatment of illnesses in adults. With 130,000 members, ACP is the largest medical-specialty organization and second-largest physician group in...
(ACP), expressed support for the idea behind the IPAB, saying "making complex Medicare payment and budgetary decisions is very difficult within a political process with substantial lobbying pressures", but the group would like to see significant changes. The ACP supports creating a position for a primary care physician on IPAB, additional protections that ensure cost reductions do not lead to lower quality of care, authority for Congress to reject proposals made by IPAB via a simple majority vote, and equal treatment of all healthcare providers.
Dr. Elaine C. Jones, government relations committee cochair of the American Academy of Neurology
American Academy of Neurology
The American Academy of Neurology is a professional society for neurologists and neuroscientists. As a medical specialty society it was established in 1949 by A.B. Baker of the University of Minnesota to advance the art and science of neurology, and thereby promote the best possible care for...
stated, "We are also very concerned about the power of the IPAB to cut payments to physicians. The sole function of the IPAB is to cut spending with little guarantee of maintaining quality, access, and scientifically proven care. There may be no physician representation on the board either. These elements are concerning and unacceptable."
Ron Pollack, the founding executive director of the health care advocacy group Families USA
Families USA
Families USA is an American non-profit consumer health-care advocacy organization. It was co-founded by attorney Ronald Pollack, its current executive director, and Philippe Villers, the organization's current President....
, advised Democrats against being divided and conquered by supporting repeal of specific portions of the health care reform, such as IPAB.
Two major nursing home associations, the American Health Care Association
American Health Care Association
The American Health Care Association is non-profit federation of affiliated state health organizations, together representing more than 10,000 non-profit and for-profit assisted living, nursing facility, developmentally-disabled, and subacute care providers that care for more than 1.5 million...
and the American Association of Homes and Services for the Aging, along with seventy two other healthcare groups, urged Congress to reject IPAB. They argued that the board would have too much control over Medicare and would affect the ability of healthcare providers to lobby for changes in how they are reimbursed. The groups also argued that IPAB would only be accountable to the president.
The American Academy of Orthopedic Surgeons
American Academy of Orthopedic Surgeons
The American Academy of Orthopaedic Surgeons is an orthopaedic organization.-Characteristics:Founded at Northwestern University in 1933, the AAOS has grown to include over 36,000 members. The group provides education and practice management services for orthopaedic surgeons and allied health...
has made IPAB a focus of their advocacy work. Hospital exemptions from 2015 to 2020 as well as the lack of practicing physicians on the board itself are major concerns. Recent lobbying efforts in April of 2011 have focused on making these modifications if not fully eliminating this board.
Editorials
In an editorial opposing Sen. Cornyn's bill to repeal IPAB the Washington Post wrote, "The political system failed when it came to controlling health-care costs. The 15-member panel that Mr. Cornyn et al. deride as 'beltway bureaucrats' would be a group of experts in the field, nominated by the president, chosen in part by congressional leaders of the opposing party and subject to Senate confirmation. Congress isn't bound by its proposals if lawmakers can come up with what they think is a better approach. Getting costs under control is going to require difficult choices -- including, in the case of Medicare, difficult political choices. This unwise bill is not a good sign about Washington's willingness to make them."Congressional Budget Office scoring
The Congressional Budget OfficeCongressional Budget Office
The Congressional Budget Office is a federal agency within the legislative branch of the United States government that provides economic data to Congress....
(CBO) estimated that IPAB will achieve Medicare spending reductions of twenty eight billion through 2019—amounting to 0.04% of the projected Medicare spending of ~$7 trillion for the period.
In March 2011, the CBO estimated the Medicare baseline level of spending would not exceed targets throughout the years of 2015 to 2021; thus, the IPAB was not expected to affect any Medicare spending.
Fiscal commission report
The 2010 presidential commission, the National Commission on Fiscal Responsibility and ReformNational Commission on Fiscal Responsibility and Reform
The National Commission on Fiscal Responsibility and Reform is a Presidential Commission created in 2010 by President Barack Obama to identify "…policies to improve the fiscal situation in the medium term and to achieve fiscal sustainability over the long run."...
, issued a report on reducing the federal deficit and voted to strengthen the IPAB 11 to 7. It wished to bring forward the time by which health care providers would be affected by IPAB decisions. The recommendations "would hit hospitals the hardest, which gained an exemption from the group’s decisions for several years".
Lawsuit
As part of legal challenges from conservative organizations and state attorneys general in about twenty states to the Affordable Care Act, Arizona's conservative Goldwater InstituteGoldwater Institute
The Goldwater Institute is a Phoenix, Arizona-based conservative public policy research organization established in 1988. The president is Darcy A. Olsen. The Goldwater Institute advances public policies with emphasis on lower taxes, limited government spending, school choice, and a reduction in...
, along with three Republican congressman from Arizona, filed a suit challenging the constitutionality of the IPAB. The Hill reported that "while the suit illustrates conservative frustration with the federal government, the courts rarely strike down advisory boards created by Congress".
See also
- Specialty Society Relative Value Scale Update CommitteeSpecialty Society Relative Value Scale Update CommitteeThe Specialty Society Relative Value Scale Update Committee or Relative Value Update Committee, is a private group of 29 mostly specialist physicians who have made highly influential recommendations on how to value a physician's work when computing health care prices in the United States' public...
- Health care rationingHealth care rationingHealth care rationing refers to governmental mechanisms that are used to allocate health care when resources are scarce. Countries differ upon the mechanisms they use to ration the distribution of health care...
- Healthcare reform in the United States
External links
- David Newman and Christopher M. Davis. The Independent Payment Advisory Board. Washington, D.C.: Congressional Research ServiceCongressional Research ServiceThe Congressional Research Service , known as "Congress's think tank", is the public policy research arm of the United States Congress. As a legislative branch agency within the Library of Congress, CRS works exclusively and directly for Members of Congress, their Committees and staff on a...
, 2010. - Henry Aaron, PhD. The Independent Payment Advisory Board. New England Journal of Medicine, 2011.
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