The Sleeping Danger

Some suggest the Independent Payment Advisory Board (IPAB) is a beast without teeth.  After all, President Obama has yet to nominate any individuals to serve on the 15-member board, and lower-than-norm Medicare spending increases suggest that IPAB wouldn’t be triggered to act anyway to cut Medicare costs.  That’s the benign view.  By contrast, the American Association of Neurological Surgeons in its Neurosurgery Blog referred to IPAB yesterday as “No Good Rotten Very Bad News for Medicare.”

On the whole, we believe the neurosurgeons’ perspective is the correct one.

Yesterday, Congressman Phil Roe (R-TN) and a bipartisan list of cosponsors introduced the “Protecting Seniors’ Access to Medicare Act,” a measure that would repeal IPAB.  It’s imperative that Congress act on this legislation this year and not put the issue on a back burner in the mistaken belief that is not a real threat to Medicare beneficiaries.

As to the matter of the President not yet nominating anyone to serve as IPAB members, Margot Sanger-Katz pointed out in yesterday’s National Journal that IPAB’s power does not disappear with a lack of appointees.  The board’s power doesn’t disappear, but rather shifts to the Secretary of Health and Human Services, still leaving the executive branch with unprecedented powers over Medicare spending that are traditionally (and, we believe, constitutionally) reserved for Congress.

Also, leaving IPAB in place creates a false sense of security that reforming the Medicare program is not an urgent imperative, that a failsafe mechanism is there to keep spending increases from becoming excessive.  But, as I pointed out in my letter to Congressman Roe yesterday, “”the bulk of any recommended spending reductions will almost certainly come in the form of payment cuts to Medicare providers.  This will affect patient access to care and innovative therapies.”  Certainly, the number of health providers refusing to see new Medicare patients because of comparatively low reimbursement rates on the increase, arbitrary IPAB cuts that focus on numbers without regard to access, quality or value represent an ill-conceived solution to Medicare’s financial challenges.

IPAB may not look particularly dangerous to millions of Medicare beneficiaries at the current moment, but it inevitably will be.  It needs to be defused before it can do serious damage.