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    GOP steps up efforts to repeal payment board established by the Patient Protection and Affordable Care Act

    High court's upcoming health law ruling could kill the IPAB


    Bob Gatty
    Washington—Republicans have most likely given themselves a major and potentially emotional campaign issue designed to appeal to those on Medicare, as well as to many physicians, when they go to the polls in November.

    On March 22, the GOP-controlled U.S. House of Representatives voted to repeal the controversial Independent Payment Advisory Board (IPAB), established by the Patient Protection and Affordable Care Act (ACA) now being challenged in the U.S. Supreme Court, and intended to provide a mechanism to control increasing Medicare costs.

    Repeal of the IPAB has been sought by large numbers of physician groups, including the AUA, which see the IPAB as an unfettered entity whose purpose will be to slash Medicare reimbursement rates for procedures and services in order to reach pre-established expenditure targets.

    Such an action, opponents say, will ultimately lead to rationing of care.

    While Republicans in the Senate are pushing for IPAB repeal, Democrats are still in control there and are not expected to support the measure, which President Obama has promised to veto even if it should pass.

    The election-year strategy of House Republicans became clear when they included in the IPAB repeal legislation provisions that would limit medical malpractice awards, also an objective of the medical community but strongly opposed by many Democratic lawmakers.

    While some observers speculated that IPAB repeal might be supported by enough moderate Democrats for it to squeak through the Senate, adding the malpractice caps only served to dilute that support and virtually guarantee the issue will be front and center during the fall campaign, giving Republicans the opportunity to reprise their warning of a "death panel" making life and death decisions regarding seniors.

    High court's ruling critical

    Adding to the uncertainty for physicians is the question of how the U.S. Supreme Court will rule on the challenge to the ACA it is now considering. Should the Court rule that the entire law is unconstitutional, the IPAB will be history. However, if it upholds the law or only tosses out specific provisions, such as the requirement that individuals must purchase health insurance or pay a penalty, then the IPAB will remain.

    The AUA has urged its members to contact lawmakers urging IPAB repeal, joining other medical society members of the IPAB coalition that have made this a lobbying priority.

    The AUA points out that IPAB's sole job is to recommend Medicare cuts to Congress and reduce the per capita rate of growth in Medicare spending if a yearly spending target is not met. The IPAB is not allowed by law to recommend necessary payment increases.

    The AUA makes these points:

    • In its first 5 years, the IPAB can only recommend cuts in Medicare to physicians and a few other provider types. However, hospitals, nursing homes, and most other providers are exempt from the cuts.
    • Cuts are capped at 0.5% for 2015, 1% for 2016, 1.25% for 2017, and 1.5% for 2018 and beyond. However, because only a portion of Medicare providers can be cut in the first 5 years, they will bear a large burden.
    • The IPAB cannot recommend increasing Medicare premiums, co-pays, or deductibles, and cannot recommend benefit changes or eligibility restrictions.
    • Recommended cuts must come from within Medicare, not outside sources of revenue.
    • IPAB's recommendations become law each year unless Congress acts to overturn them or blocks or makes changes and identifies alternative cuts within the Medicare program.

    In remarks on the Senate floor the day the House approved the legislation, Sen. Tom Coburn, MD (R-OK), a colon cancer survivor, cautioned that one of the first things that would be cut by the IPAB would be the reimbursement rate for colonoscopies.

    What would happen when the rate for the procedure goes below costs? he asked.

    "What the American people need to understand is what is coming about is a group of 15 unelected bureaucrats who cannot be challenged in court, who cannot be challenged on the floor of the Senate or House, mandating price reductions to control the cost of Medicare," Dr. Coburn said.

    Dr. Coburn also pointed out that the IPAB will be performing "comparative effectiveness research," which, he contended, will be used "to deny or change payments for procedures that patients need."

    What's wrong with all of this? Dr. Coburn asked.

    "We are inserting a government board and government bureaucrat between the patient and the doctor. When I go to my doctor, I don't want him concentrating about anything except me. And if he's looking over his shoulder about whether or not he met the IPAB's comparative effectiveness study on what he's doing for me when, in fact, the art of medicine as well as the science may say they're wrong... he's going to do what the government says rather than what he thinks is best for me."

    Added Dr. Coburn, "The greatest threat for quality of care for seniors in this country is the Independent Payment Advisory Board and their non-caring position, because they're going to be looking at numbers and words, and they're never going to lay their hand on a patient. They're never going to impact a patient directly. They're never going to listen to a patient. But they're going to make the ultimate decisions based on what that patient's going to get."

    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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