ipab

IPAB notes

the independent payment advisory board - us gov agency created in 2010 by ACA (affordable care act)

task

-reduce rate of growth in medicare to target levels w/o adversely impacting coverage/quality

priveleges

-IPAB has the ability to set medicare reimbursement rates independently, only congress has ability overrule IPAB decisions

thesis

-orginally MedPAC (medicare payment advisory commission) could advise congress on proper medicare spending but MedPAC could not legislate, however congress never made MedPAC's suggested cuts. it is believed congressional members were beholden to special interest groups from medical device/supply makers to keep spending high, IPAB was proposed as a way to remove power from congress with these financial conflicts of interest and put medicare spending policy decisions in the hands of healthcare policy experts

IPAB guidelines

-proposals must not involve "rationing" of care

-proposals must not raise medicare premiums

-proposals must not increase cost sharing (deductibles, copayments, coinsurance)

-proposals must not restrict benefits

-proposals must not alter eligibility criteria

who makes up IPAB

-15 members appointed by president, confirmed by senate

-composed of healthcare administrators, physicians, hospital managers, healthcare IT managers, consumer group representatives

-member salary 165,000

-total funding $15 million

notable organizations against IPAB

-pharmaceutical research and manufacturers of america -

-american hospital association

-american medical association - wants "working" physicians to be included as board members

-american academy of neurology - concerned reimbursements will be cut, believes there will not be physician representation on the IPAB board

-nursing home associations - IPAB would adversely impact their ability to lobby congress (this is as i understand it the whole purpose the board was created)

those for it

-medicare benficiaries stand to benefit, provided they can access care

-washington post editorial - reject criticism of IPAB essentially by saying that the current political system is failing greatly

numbers

-IPAB goal- decrease by $28 billion by 2019 - total medicare spending for this period will be 7 trillion!!, thus the savings will amount to 0.04% of total spending

my opinion is that this panel could probably be a benefit to healthcare reform and i support its formation. i understand opposition to IPAB probably stems from the loss of revenue and pre-existing political relationships between special interest lobbyists and congress. disrupting this channel of communication definitely adversely impacts these institutions' profit equilibrium and political position, and those who have spoken out against IPAB probably feel that their interests will be adversely impacted by IPAB proposals. but i happen to believe that congress would sell out the interests of physicians in order to maintain ties with private insurance and hospital lobbying groups who are more integral to their re-election, and because of the inherent instability that those relationships place on my standing as a future physician taken together with the good faith effort of our president and healthcare reform analysts comprising the IPAB (who may be more aligned with interests of office based/general practice physicians), i see more reason to support the formation of the IPAB then to maintain the status quo of medicare reimbursement defined in my eyes by annual emergency medicare reimbursement reduction stopgaps passed at the eleventh hour which continuously place the reimbursement system for physicians in precarious straits.