AGA Washington Insider

A policy blog for GIs

Why Should GIs Care About IPAB?

I, along with several of my colleagues, attended the Alliance of Specialty Medicine’s annual legislative conference during which we heard from legislators from both houses of Congress and both sides of the aisle about health-care reform and how it may affect our practice of GI. 

A major issue of concern to all of the specialists who attended the meeting was the Independent Payment Advisory Board (IPAB) included as part of the Patient Protection and Affordable Care Act. AGA and the alliance strongly oppose IPAB and urge its repeal. 

For those who may not be aware, the IPAB is a 15 member board appointed by the president and confirmed by the senate. This board is authorized to make changes to Medicare reimbursement without congressional input and, by 2015, must slow the growth of Medicare spending to a rate of per capita gross domestic spending, plus 1 percent.

So, why are we opposed to the IPAB? 

One can argue that IPAB was created for the right reasons — to reduce the high costs of health care. We all agree that we have to deal with the high costs of health care. IPAB, however, is not the solution. We need to deal with health-care costs in general and not focus again on physicians and seniors. Our energies should be redirected to finding a solution that will work across the board, before we create another new problem. But, IPAB creates another problem — one that specifically affects physicians, specialists and senior citizens. 

Problematic issues inherent to the creation of this board are numerous: 

  1. This group of 15 unelected, unaccountable individuals will have the authority to make significant changes to Medicare, without the expertise of a single practicing physician on the board. It lacks the input required when making health-care decisions that will not only have a negative impact on physician practices, but also on the quality of care patients receive. 
  2. The creation of IPAB takes the power to manage Medicare reimbursements away from congress and gives it to the executive branch. Proposals made by the board will be sent to congress under unprecedented fast track procedures, where it will automatically become law unless blocked by a 60 vote super majority of the senate. This entire process grants unprecedented, less transparent authority over Medicare to an unelected body. 
  3. IPAB cuts will focus disproportionately on physician reimbursements. Hospitals and others that are responsible for two thirds of Medicare spending are exempt from payment cuts until 2019. The board is largely limited to meeting cost goals by cutting costs to providers. 
  4. The end result of the board’s proposals will mean a further reduction in the already low reimbursement rates for physicians who treat Medicare patients. Doctors will not be able to accept as many Medicare patients and access for our seniors will be further limited. 
  5. The Patient Protection and Affordable Care Act precludes IPAB from rationing health care directly, but the board’s decisions may have the same effect. IPAB has been compared by some to the National Health Service in the United Kingdom, the mechanism intended to make recommendations and cut costs. In March, critics in the UK contended that 20,000 people died after the agency rejected cancer medications due to cost-effectiveness. 

As gastroenterologists, how are we affected? Our volume is high and a great proportion of our patients are seniors. Another grave concern for gastroenterologists and our patients is that the IPAB could decide that a cheaper modality for detecting colorectal cancer should be the only screening test covered for seniors and screening techniques like colonoscopy should not be covered. 

What can we do? Members of both sides of the aisle are opposing the IPAB — that is the good news. We, along with other specialists, need to support legislation H.R. 452, the “Medicare Decisions Accountability Act of 2011,” which would repeal the IPAB.

Perhaps we can eliminate this problem now, before it’s too late, rather than compound the ones we already are living with. Contact your legislators and encourage them to become a co-sponsor of the legislation to repeal IPAB.

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