Medicare payment advisory board in Congress’ crosshairs

If Rep. Phil Roe (R-Tennessee) gets his way, the Independent Payment Advisory Board (IPAB) will soon be eliminated.

IPAB was established in 2010 to cut Medicare spending if the program’s five-year growth rate rose faster than a target growth rate. Because IPAB could make those cuts without Congressional oversight, Roe is concerned not only about how reductions in Medicare spending would affect its 57 million beneficiaries, but also how those cuts might cause physicians to stop accepting new Medicare patients. 

Roe is cosponsoring bipartisan legislation-The Protecting Seniors’ Access to Medicare Act of 2017-in the U.S. House of Representatives and he has 230 cosponsors. A corresponding bill is in the works in the Senate, sponsored by Sen. John Cornyn (R-Texas). Roe believes that if Congress passes legislation, President Donald Trump would sign it into law. “Physicians who treat Medicare patients can afford to take only so much in terms of cuts in what they get paid,” he told Medical Economics. “If you cut too deep, doctors will bail.” 

The American Medical Association (AMA) expressed those same concerns in testimony submitted in July to the House Committee on Energy and Commerce Subcommittee on Health. “Arbitrary IPAB physician payment cuts may create Medicare access issues for beneficiaries,” the AMA said. “Specifically, physician reimbursement under Medicare could become so low that physicians stop accepting Medicare patients.”

The Board of Trustees for Medicare said the projected five-year average growth in Medicare per capita spending would be 2.14%, below the five-year average growth rate target of 2.87%.

In the past year, the report showed, the fund’s financial outlook improved because health costs rose more slowly than expected and Medicare patients used hospital services less frequently than federal officials had predicted. Under current projections, the trust fund should last through 2029.

Before the trustees’ report, Roe was concerned that the growth rate would exceed the target, triggering the need to convene IPAB.  

In addition to bipartisan support in both houses of Congress, the bills have support from more than 760 organizations representing patients, physicians, other providers, employers, veterans and Americans with disabilities that want IPAB eliminated, according to the Healthcare Leadership Council (HLC). The council is comprised of CEOs representing healthcare stakeholders. 

Any cuts IPAB would make could affect senior citizens who depend on the program. Those seniors would likely blame Congress for any problems that result, which would reflect poorly on Congress, Roe says. “That’s an abdication of our constitutional responsibility, which is to the power of the purse,” he comments. “That makes no sense. We’re the ones who have to answer to people when we go home.”

In a statement, HLC President Mary R. Grealy said the fact that IPAB would not convene this year does not remove the threat the board poses. If growth exceeds the target next year, IPAB could be convened. 

“Reducing what Medicare pays for healthcare services-widening the reimbursement gap between Medicare and private insurance-can only harm seniors and beneficiaries with disabilities,” she says. 

Joseph Burns is an journalist in Falmouth, Massachusetts. Do you think this bill would help your patients? Tell us at medec@ubm.com.