Is the IPAB Still Alive and Well?

Feared and Disliked

The Independent Payment Advisory Board (IPAB), which would cut Medicare reimbursements to doctors if Medicare inflation reaches a certain target, is strongly feared and disliked among many physicians and physician groups. While it isn't dead, and many consider it still to be a potential threat, the movement to kill it is gaining momentum.

Certainly, many groups in Washington want to do away with the IPAB. But the board, created by the Affordable Care Act (ACA), always manages to dodge the bullet.

The controversial panel's latest near-miss occurred on March 30, when the Supreme Court decided^[1] not to hear a lawsuit alleging that the IPAB illegally removes lawmaking authority from Congress. As is its custom, the high court didn't explain why. However, an appeals court had already dismissed^[2] the case as "unripe," directing that the plaintiffs would have to wait until the IPAB actually starts cutting costs.

Experts agree, though, that the panel won't start cutting anytime soon. Medicare inflation has been at historic lows and is likely to stay that way for at least a few years. This makes IPAB opponents nervous. A hibernating board could easily be ignored, until it starts taking action many years from now.

This year, however, forces against the cost-cutting board are beginning to come together, according to Rep. Phil Roe, MD (R-Tennessee). Dr Roe introduced a bill^[3] to repeal the IPAB, which passed the House 3 years ago. And when Republicans took over the Senate in January, within days they had introduced similar legislation.^[4] In March, Dr Roe introduced a new House version of the bill.^[5]

New GOP-Run Congress Targets the IPAB

Dr Roe said GOP control of both houses of Congress means that for the first time since the ACA was passed, an IPAB repeal bill could go directly to President Obama's desk. If the President wants to save the board by using his veto power, he has to deal with bad press over propping up an unpopular panel, as his party heads into a crucial election.

Even among many Democrats, the IPAB is regarded as an overly bureaucratic apparatus that takes important powers away from elected representatives and may even ration care. Influential figures such as former Democratic National Committee Chairman Howard Dean, MD, have come out^[6] against it.

The board would have unusual cost-cutting powers, primarily directed at physicians. The ACA exempts the IPAB from judicial review and requires a three-fifths majority for Congress to overrule its cuts. Because hospitals would be exempt from IPAB cuts until 2020 and extra payments can't be forced on beneficiaries, the IPAB would have little else to do but target physician pay.

"IPAB is a terrible idea," Dr Roe says. "It's one of the worst ideas in the whole healthcare bill, even worse than the SGR [sustainable growth rate]." The SGR was finally removed on April 16, ceding its place as physicians' most hated cost-cutting mechanism to the IPAB. "All the work we've done to pass the SGR replacement could be trumped by IPAB," the congressman warns.

Medscape Business of Medicine © 2015  WebMD, LLC

Cite this: Leigh Page. Is the IPAB Still Alive and Well? - Medscape - May 28, 2015.