AAFP, ACP Break Ranks With Organized Medicine on IPAB

May 07, 2013

In This Article

Last month, Congress received no ordinary letter urging it to repeal the controversial Independent Payment Advisory Board (IPAB), created by the Affordable Care Act (ACA) to curb the growth of Medicare spending.

The letter's 506 signatories, a veritable grab bag, ranged from a senior citizens center in Pocatello, Idaho, to PhRMA, the powerful trade association for drug manufacturers. Also weighing in were dozens of state and national medical societies that included the American Medical Association (AMA), the American College of Surgeons, the American College of Radiology, the American Academy of Neurology, and the American College of Obstetricians and Gynecologists.

Conspicuously missing from the list were 2 medical societies representing the bulk of the nation's primary care physicians — the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).

Both groups support the general concept of IPAB, although they have lobbied for changes to its composition and power. The absence of the 2 groups from the IPAB repeal letter says a lot about what primary care physicians expect from healthcare reform. They believe the ACA entity might reduce Medicare pay for tests, diagnostic imaging, and procedures, widely deemed to be overvalued, and increase it for undervalued evaluation and management (E/M) services, the bread and butter for their field. The shorthand expression for this redistribution of Medicare dollars is "correcting misvalued codes," as in billing codes.

The losers in this payment shift would be specialists, according to Robert Berenson, MD, a fellow at the nonpartisan Urban Institute.

The Medicare Payment Advisory Commission (MEDPAC) has already urged Congress to tilt reimbursement from specialists to primary care physicians, and "I suspect IPAB would similarly be sympathetic" to that position, Dr. Berenson told Medscape Medical News. As a consequence, "primary care physicians feel less threatened by IPAB."

The IPAB's marching orders as set forth in the ACA seem to favor family physicians and internists, given the primary care buzz words in the law. The board is charged with making recommendations to improve the healthcare delivery system and outcomes by, among other things, "promoting integrated care, care coordination, prevention and wellness, and quality and efficiency improvements." The IPAB provisions do not mention correcting misvalued billing codes in the Medicare fee schedule — that's in another section of the law.

Ominously for specialists, the ACA instructs the IPAB to "target reductions in Medicare program spending to sources of excess cost growth." MEDPAC points a finger at these "sources of excess cost growth" in its 2013 report to Congress. From 2000 to 2009, the volume of imaging services and tests — 2 different categories — grew by more than 80%, which is more than double the rates for E/M services and major procedures. The growth rate of other procedures topped 60%. Imaging volume tailed off in 2010 and 2011, and major procedures did so in 2011, whereas the other services continued their ascent.


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