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    American Urological Association, lawmakers oppose Medicare advisory board

    Opponents take issue with lack of congressional oversight

    Bob Gatty
    Washington—A large number of organizations in the medical community—including the AUA—have launched a campaign to persuade Congress to repeal the Independent Payment Advisory Board (IPAB), an entity designed by Congress to take politics out of decisions involving changes to federal health programs such as Medicare.

    While it is unlikely that the Democratic–controlled Congress will pass Republican-sponsored legislation introduced in both the House and Senate to repeal the IPAB before the November mid-term elections, the chances may be significantly improved if the pundits are correct and the GOP makes massive gains in both chambers.

    Nevertheless, the AUA, other members of the Alliance of Specialty Medicine, the American Medical Association, and other physician groups are backing S.3653, the Health Care Bureaucrats Elimination Act, introduced by Sen. John Cornyn (R-TX), and H.R. 4985, the Medicare Decisions Accountability Act, introduced by Rep. Phil Roe, MD (R-TN).

    In "action alerts" sent to members, the AUA asked urologists to contact their lawmakers in both the House and Senate and urge them to sign on to the respective bills as co-sponsors.

    The memo pointed out that the board, created by the Patient Protection and Affordable Care Act, "effectively ends Congressional authority over Medicare payment policy." It says the board "has the power to make policy recommendations regarding health care provided in private, non-government health care settings as well."

    The AUA contends, in its action alert, that "placing such important decisions in the hands of a commission without appropriate checks and balances in Washington will have a far-reaching adverse impact, not only for Medicare beneficiaries, but for all Americans' ability to access quality surgical care in their communities."

    Board created to address SGR cuts

    A major reason behind inclusion of the IPAB in the health care reform law was the constant political problem faced by Congress in having to deal with Medicare physician pay cuts perennially required by the sustainable growth rate (SGR) formula. When those cuts are about to be implemented—as they will be later this year unless Congress steps in once again—physician groups such as the AUA besiege lawmakers asking for help.

    Under the health care reform law, beginning in 2014 the IPAB, a 15-member board of non-elected officials, will recommend Medicare spending reductions in order to meet SGR targets. The board's recommendations could take effect as early as 2015 unless Congress either passes an alternative proposal with the same level of budgetary savings or overrides the original legislation by two-thirds majorities in both houses.

    A practical result of the IPAB provision is that it will be much more difficult for physician organizations to influence ultimate Medicare fee-setting decisions. Currently, they are able to ask members of the House and Senate for help, and annually have succeeded in reducing or eliminating pending reductions.

    In an issue brief regarding the IPAB, the Alliance of Specialty Medicine points out that under current law, the SGR formula will require physician payment rates to be reduced by more than 40% over the next decade.

    "The IPAB could make cuts on top of those already set to take place," the Alliance warns. "As a result, seniors who participate in the Medicare program are at risk of losing the doctor of their choice as more physicians are being forced to limit the number of Medicare patients they see. The IPAB solution will exacerbate the problem by imposing arbitrary cuts in Medicare reimbursement rates for some providers while excluding others from its effects. As a result, there will be more pressure to extract deeper cuts from those areas under the IPAB's jurisdiction."

    "We strongly believe that the IPAB is simply the wrong approach and will result in unintended consequences that include restricting access to specialty care interventions and services for Medicare patients," the Alliance says.

    The Obama administration has promoted IPAB as necessary to control Medicare spending. In a speech July 28 at the Brookings Institution in Washington, outgoing White House budget chief Peter Orszag, PhD, said the health reform law contains the "most promising set of changes ever enacted to reduce the rate of health care cost growth over the long term."

    Budget office: IPAB will save money

    According to the Congressional Budget Office, the board will save the government $13 billion over 10 years.

    Unless it is repealed, IPAB is expected to submit recommendations to Congress that include:

    • giving priority to ways to extend Medicare solvency
    • targeting program spending reductions to sources of excess cost growth
    • considering the impact of recommendations on physicians and suppliers with actual or projected negative cost margins or payment updates
    • zero increases in net program spending over 10 years
    • submitting a draft copy of each proposal to MedPAC.

    IPAB can begin submitting recommendations Jan. 15, 2014.

    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.


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