AAFP, ACP Break Ranks With Organized Medicine on IPAB

May 07, 2013

In This Article

An End Run Around Lobbyists?

Congressional Republicans have repeatedly sought to repeal the IPAB in what has been a symbolic quest so far, given a Democrat-controlled Senate and a promised veto from President Barack Obama.

The IPAB sharply divides politicians and medical societies alike. That's not surprising for a group dubbed an ACA "death panel" by political conservatives who believe its intent is to ration healthcare.

"Obama's IPAB is the true death panel," explains a recent letter from the Association for Mature American Citizens, a self-described conservative counterpart to the AARP. "If they decide you are too old or the treatment you need costs too much, tough luck, better stay healthy."

The AMA and the other 505 signatories to the letter to Congress do not use the words "death panel" and "ration," but they nevertheless warn that the IPAB could hurt patient care by causing more physicians to turn away Medicare patients.

"The bulk of any recommended spending reductions will almost certainly come in the form of payment cuts to Medicare providers," the groups write. "This will affect patient access to care and innovative therapies."

The letter voices other gripes about the new board. "IPAB will have unprecedented power with little oversight," the signatory groups write. They say that the ACA takes away the job of setting healthcare payment policy from Congress and puts it in the hands of "an unelected and unaccountable board."

This talking point divides organized medicine. Leaders of the ACP and AAFP told Medscape Medical News that the notion of an independent board has merit. "We think that members of Congress aren't really trained in health policy, and so an independent body that can make recommendations is probably worthwhile," said Charles Cutler, MD, chair of the ACP board of regents.

"We support the concept of a nonpartisan group of experts judging misvalued [billing] codes," added AAFP President Jeffrey Cain, MD.

There is more to the desire for an independent board than what politicians know or do not know about healthcare policy. Removing Medicare payment decisions from Congress means bypassing healthcare industry lobbyists who command votes through campaign contributions. The ACP said as much in Congressional testimony in 2011: "The College believes that an independent board of healthcare experts...would be more likely to achieve the needed Medicare changes and be less affected by special-interest influence."

Some of that special interest influence is exerted by manufacturers of medical devices, who have common cause with procedure-oriented specialists. The Urban Institute's Dr. Berenson recalls how the makers of diagnostic imaging equipment quickly rallied some 180 members of Congress to oppose (unsuccessfully) the Deficit Reduction Act of 2005, which cut Medicare reimbursement for advanced imaging services.

"Congress is very responsive to stakeholders' interests," Dr. Berenson said about the role of lobbyists. "It's democratic — that's the good thing. The bad thing is the role of special interests.

"I have mixed feelings about IPAB, because it's not democratic in an important way."


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