Back on the agenda
Repeal of contentious IPAB moves forward
After fading into the background, the debate over the Independent Payment Advisory Board resurfaced last week as a House subcommittee voted to repeal the panel that the White House has yet to appoint.
Discussions surrounding IPAB reached a fever pitch last summer (July 18, 2011, p. 6) when HHS Secretary Kathleen Sebelius testified before two congressional committees about the 15-member panel, which will be responsible for suggesting ways to restrict Medicare cost growth. The talk subsided as conversations regarding the debt ceiling, the deficit-reduction supercommittee and the payroll tax bill (including a temporary fix to Medicare’s physician payment formula) took center stage. But neither Congress nor providers have forgotten the issue.
On Feb. 29, the House Energy and Commerce health subcommittee voted 17-5 to approve the Medicare Decisions Accountability Act of 2011, a bill introduced by Rep. Phil Roe (R-tenn.), a physician, to repeal IPAB. And the bill has received bipartisan support, as 19 of its 230 co-sponsors are Democrats.
Also last week, the American Hospital Association sent a letter to Roe that expressed support for his bill. The AHA has been a strong opponent of IPAB, even though hospitals, inpatient rehabilitation
facilities, hospice care and some other segments are exempt from the board’s purview through December 2019.
Richard Pollack, executive vice president of the AHA and author of the letter to Roe, said in an interview last week that his organization opposes IPAB for three reasons. The first is that hospitals will already face cuts through payment reductions in the Patient Protection and Affordable Care Act and sequestration that is scheduled to take effect next year. Next is the idea that members of Congress, not IPAB, know best what is happening in their respective communities. Mostly, though, the AHA sees IPAB only as a board that will recommend more payment reductions.
“They can only do one thing—cut providers,” Pollack said. “We’re not talking about an entity that will make structural reforms that affect all stakeholders. We’re looking at another vehicle to make arbitrary cuts to providers.”
Meanwhile, the question lingers: Why has the White House not yet appointed the members—who will require Senate confirmation—to the board? Some observers have said it will be hard to find the appropriate people for this full-time job in the current political environment. In a House Ways and Means Committee hearing last week, Rep. Paul Ryan (R-wis.) asked Sebelius if the administration had a timeline to name the board and noted that IPAB is expected to report to Congress in 2014. Sebelius replied that she had no such timeline, but that there are “active discussions” about it.
The lack of urgency on the matter from the administration could relate to a slower rate of growth in Medicare spending. HHS officials said in an e-mail that according to the latest long-term projections from the CMS actuary’s office, the first year the IPAB’S proposals have the potential to be in place would be in 2018.
“The law says that the actuary will begin making determinations in 2013 (for 2014 delivery to Congress), and it’s that process that will determine whether the recommendations have the potential to be binding,” it continued. “While the recent slowing in Medicare cost growth suggests that savings targets will be limited for the foreseeable future, the administration is committed to working with Congress to ensure IPAB is operational and able to fulfill its statutory requirements as soon as practicable.”
The House Ways and Means health subcommittee will examine IPAB in a hearing this week.