Independent Medicare Payment Board Up for Grabs

WASHINGTON — Following the introduction last week of
House and
Senate bills that would repeal the medical device tax
instituted under the Patient Protection and Affordable Care Act,
lawmakers in the House introduced legislation to repeal a provision
in the health reform law that created an Independent Payment
Advisory Board for Medicare.

The proposed Medicare Decisions Accountability Act (H.R. 452)
was introduced Jan. 26 by Rep. Phil Roe, R-Tenn., a physician, and
cosponsored by 23 other Republicans.

To begin operation in 2014, the IPAB will be a 15-member
independent panel — with members appointed by the president
— that could set Medicare reimbursement that would become law
unless Congress intervenes.

Industry lobbyist Cara Bachenheimer, senior vice president of
government relations for Invacare, explained that the board is
charged with enforcing an upper limit on annual Medicare spending
growth. “Under the health reform law, Medicare spending is now
officially capped,” she said.

“Beginning in 2015, Medicare spending is now supposed to be
limited, on a per capita basis, to a fixed growth rate, initially
set at a mix of general inflation in the economy and inflation in
the health sector. Starting in 2018, the upper limit is set
permanently at per capita gross domestic product growth plus one
percentage point.”

The IPAB, then, will be responsible for making recommendations
to Congress that would cut payment rates to keep Medicare spending
within the prescribed limits. At that point, Bachenheimer said, “If
Congress does not act — either vote for or against them
— then the Department of Health and Human Services is
required to implement IPAB’s recommendations.”

Proponents of the independent Medicare board believe it will
effectively curb spending growth in the massive program. The
Congressional Budget Office has estimated the IPAB would save $15.5
billion between 2015 and 2019, the years in which its
recommendations will be implemented.

But critics say creation of the board takes accountability for
the operation of Medicare from lawmakers and gives it to unelected
officials. Roe believes the move could curtail access and care for
beneficiaries if physician payments are cut.

“Health care decisions should be made between a physician and
the family. You don’t need an administration-approved bureaucrat
doing it,” Roe told reporters at a Jan. 26 press conference.

“Congress’ traditional role of controlling payment rates will be
eliminated by this IPAB, if indeed Congress chooses to not act on
the IPAB recommendations,” said Bachenheimer, who last year called
the board’s creation the “scariest” provision in the health reform
law.

Does she still feel that way?

“Most definitely,” Bachenheimer said Friday. “It gives this
commission essentially unfettered authority to reduce payments to
Medicare providers across the board.”

Read more of Roe’s thoughts on the independent board in his July
2010 op-ed piece in The Washington
Times.