Economists and scholars defend Medicare pay board

Supporters say the IPAB is necessary to cut costs and improve care. The AMA and other critics say it could implement SGR-like pay cuts.

By Charles Fiegl amednews staff — Posted June 2, 2011

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More than 100 academics, analysts and economists are pressing Congress to preserve the Medicare Independent Payment Advisory Board to promote new payment methods and improve the program.

Momentum has been building in Washington, led by House Republicans, to pass legislation that would repeal the board as authorized by the health system reform law. A House bill sponsored by Phil Roe, MD (R, Tenn.), has 120 co-sponsors, including several Democrats, who support eliminating the IPAB. President Obama instead has called for the cost control board's charter to be expanded in an effort to curtail Medicare spending growth.

A letter from 106 professionals at universities and think tanks across the country urges lawmakers to keep the board intact.

"The IPAB is a tool designed to help the Congress slow the rapid projected increases in health care costs in the federal budget and to improve the delivery of health care," the May 20 letter states. "Increases in Medicare, Medicaid and the private sector could be slowed by giving providers greater incentives to adopt more cost-effective treatments and prevention interventions."

Congress should "mobilize the expertise of professionals" who can study payment policy and would propose solutions to problems plaguing the system, the letter continued.

The letter's signatories include physicians Shari Bolen, MD, MPH, of Case Western Reserve University, Cleveland; Nancy Keating, MD, MPH, J. Michael McWilliams, MD, PhD, and Michael Wilson, MD, of Harvard Medical School, Boston; William Sage MD, of the University of Texas; Barbara Starfield, MD, MPH, of Johns Hopkins University, Baltimore; and William Terry, MD, of Brigham and Women's Hospital, Boston.

The American Medical Association and other physician organizations have significant concerns about the IPAB. The board would establish another arbitrary system with the potential for imposing doctor pay cuts similar to those mandated by the sustainable growth rate formula, the AMA has said. The Association has urged Congress and the Obama administration instead to work together on reforms that strengthen Medicare instead of handing off decisions to an unelected board.

Analysis by conservative groups, such as the Heritage Foundation in Washington, D.C., have concluded that the IPAB would fail to control costs. Under current law, Congress has prevented SGR cuts to Medicare since 2003, and lawmakers likely would override future cost control measures that adversely affect physicians and patient access, the foundation said.

Some Republican opponents in the Senate have vowed that the GOP will block the nomination of any official to the IPAB if the board is still in place in 2014, when it is scheduled to launch.

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