Back on the agenda

Repeal of con­tentious IPAB moves for­ward

Modern Healthcare - - THE WEEK IN HEALTHCARE - Jes­sica Zig­mond

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.

Roe’s IPAB repeal bill has bi­par­ti­san sup­port.

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