AAFP, ACP Break Ranks With Organized Medicine on IPAB

May 07, 2013

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Primary Care Rx for Improving IPAB

Unlike most of organized medicine, the ACP and the AAFP are content to revise the IPAB instead of repealing it.

Both groups agree that 1 of the board's 15 seats should belong to a primary care physician because primary care, in their view, is the foundation of a healthy healthcare system. As the law stands now, the IPAB must include physicians — specialty unspecified — in addition to other healthcare providers, nationally recognized experts in matters of healthcare finance and delivery, and representatives of consumers and the elderly. "We are concerned that internal medicine physicians will not be heard," said the ACP's Dr. Cutler.

The 2 medical societies also object to an ACA provision that spares hospitals and nursing homes from any IPAB cost-cutting until fiscal 2020. All Medicare providers and suppliers should immediately come under the scalpel, according to the ACP and AAFP.

Although both societies support the concept of an independent cost-control board, they do not want it to be freewheeling. The AAFP has proposed building in a public comment period for IPAB proposals. The ACP has called for an even stronger check: allowing Congress to override the board's recommendations with a simple majority rather than a supermajority.

"The College agrees with the position of many of the other physician organizations that the current-law provision removes too much authority from Congress and their ability to be accountable to the public," ACP Immediate Past President David Bronson, MD, wrote to Congress last summer when he was the group's president.

The ACP's Dr. Cutler told Medscape Medical News if Congress were to adopt his group's prescription for revising the IPAB, "it may well be that all medical organizations would sign on to it." The divide between the ACP and the rest of organized medicine "is not as great as you might think," he said.

Dr. Cain at the AAFP calls his group's position on the IPAB "nuanced." The AAFP does not appear as a signatory to the recent letter calling for the board's demise "because we were not asked to be on that letter," he said. His group "opposes IPAB in its current configuration," but the opposition would end if Congress accedes to its proposed reforms.

"We support the concept of IPAB," said Dr. Cain. "We think IPAB would ultimately recognize the value of primary care and reward it differently." Such a financial boost, he said, could result in higher-quality patient care at a lower cost. In addition, increased pay might swell the ranks of a shorthanded primary care workforce.

In other words, IPAB could be a very good thing.

"If it is improved," said Dr. Cain. "That's the nuance."


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