Providers wary of board's charge to con­trol Medi­care spend­ing

Modern Healthcare - - Front Page -

With all of the noise out of Wash­ing­ton about ways to re­duce Medi­care costs, health­care providers crave a clear mes­sage about what their fu­ture with the fed­eral pro­gram will look like. And when it comes to the In­de­pen­dent Pay­ment Ad­vi­sory Board, that mes­sage isn’t com­ing through.

Cre­ated in last year’s Pa­tient Pro­tec­tion and Affordable Care Act, the IPAB, as it’s known, is in­tended to be a 15-mem­ber panel of pres­i­den­tial ap­pointees re­spon­si­ble for sug­gest­ing ways to re­duce the per capita growth rate in Medi­care spend­ing.

But ques­tions abound re­gard­ing who will be ap­pointed to the board and when; if those ap­pointees will be able to make it through the Se­nate con­fir­ma­tion process; why there is a need for such an agency when the Medi­care Pay­ment Ad­vi­sory Com­mis­sion al­ready ex­ists to ad­vise Congress on pay­ment mat­ters; whether pend­ing leg­is­la­tion to re­peal this pro­vi­sion will suc­ceed, es­pe­cially af­ter the pres­i­dent has sought to strengthen the board; and what this will mean for hos­pi­tals, in­pa­tient re­ha­bil­i­ta­tion fa­cil­i­ties, hospice care and other health­care seg­ments that are ex­empted from IPAB’s purview through Dec. 31, 2019, be­cause they are al­ready sched­uled to re­ceive pay­ment re­duc­tions as a re­sult of last year’s law.

The con­cept has drawn the ire of fed­eral lawmakers—even from some Democrats who strongly sup­port last year’s law—who say the panel of pres­i­den­tial ap­pointees will usurp Congress’ power to make de­ci­sions about the pro­gram. It in­cludes “fast track” pro­ce­dures that man­date the im­me­di­ate in­tro­duc­tion of leg­is­la­tion in Congress with strin­gent dead­lines for com­mit­tees and floor con­sid­er­a­tion. Congress can make changes, but only in ways that achieve the same tar­geted re­duc­tions.

And the law fur­ther ties the hands of Con- gress, which would need to muster su­per­ma­jori­ties to change the fis­cal tar­gets or block the process, which is trig­gered when Medi­care costs grow too quickly.

Ac­cord­ing to Obama ad­min­is­tra­tion of­fi­cials, the IPAB is merely a “back­stop” mea­sure. But in April, the pres­i­dent called for strength­en­ing the IPAB by giv­ing the panel the au­thor­ity to hold Medi­care spend­ing to the nom­i­nal per capita growth in GDP plus 0.5% be­gin­ning in 2018, half the rate in the cur­rent statute.

Physi­cians and hos­pi­tals strongly op­pose the IPAB con­cept al­to­gether. The Amer­i­can Hos­pi­tal As­so­ci­a­tion, in a March letter to Sen. John Cornyn (R-Texas), spon­sor of the Se­nate bill to re­peal the IPAB pro­vi­sion, wrote that the panel “threat­ens the im­por­tant di­a­logue be­tween hos­pi­tals and their elected of­fi­cials about how hos­pi­tals can con­tinue to pro­vide the high­est qual­ity care to their pa­tients and com­mu­ni­ties.” There also is House leg­is­la­tion to re­peal it, and two ex­ten­sive fed­eral hear­ings ex­am­ined the is­sue last week.

“When you lis­ten to vintage ra­dio, it’s hard to lis­ten to the sig­nal. It pops and fades and goes,” said Herb Kuhn, pres­i­dent and CEO of the Mis­souri Hos­pi­tal As­so­ci­a­tion who served as deputy ad­min­is­tra­tor at the CMS from 2006 to 2009 and is a cur­rent MedPAC com­mis­sioner.

“Congress is in the driver’s seat from day one,” Se­be­lius told the House Bud­get Com­mit­tee, al­though leg­is­la­tors fear the panel will usurp some of Congress’ pow­ers. Se­be­lius is shown tes­ti­fy­ing last week be­fore the En­ergy and Com­merce Health Sub­com­mit­tee.

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