Providers wary of board's charge to control Medicare spending
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.