Jump to content

Independent Payment Advisory Board

Add links
From Wikipedia, the free encyclopedia

This is an old revision of this page, as edited by Hauskalainen (talk | contribs) at 23:58, 2 March 2011 (Undid revision 416765361 by Jesanj As per long discussion at TALK- This breaches WP:CRYSTAL. There is a whole universe of opinions and this creates bias). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

The Independent Payment Advisory Board, or IPAB, is a United States Government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act which has the explicit task of reducing the rate of growth in Medicare without affecting coverage or quality.[1] Under previous law, changes to Medicare reimbursement rates were recommended by MedPAC but required an act of congress to take effect, but the new system devolves responsibility to IPAB with congress being given the power to overrule the agency's decisions.

The Board is required to implement its first proposals in 2015 with its first report being produced by July 2014. The Chief Actuary of the Centers for Medicare and Medicaid Services will determine in particular years the projected per capita growth rate for Medicare for the second year thereafter. If the projection exceeds a target growth rate, IPAB must develop a proposal to reduce per capita Medicare spending. The Secretary of Health and Human Services must then implement the proposal unless Congress enacts legislation pursuant to a fast-track procedure that the law sets forth.[1]

Mission

IPAB is tasked with developing specific proposals to bring the net growth in Medicare spending back to target levels if the Medicare Actuary determines that net spending is forecast to exceed target levels, beginning in 2015. The proposals must not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums, increase Medicare beneficiary cost sharing (deductibles, coinsurance, or co-payments), or otherwise restrict benefits or modify eligibility criteria.[2] The Department of Health and Human Services must implement these proposals unless Congress adopts equally effective alternatives. The board is also required to submit to Congress annual reports on health care costs, access, quality, and utilization. IPAB must submit to Congress recommendations on how to slow the growth in total private health care expenditures.[3]

Every year on September 1, IPAB must submit a draft proposal to the Secretary of Health and Human Services. On January 15 of the next year IPAB must submit a proposal to Congress. If IPAB fails to meet this deadline, the Department of Health and Human Services (DHHS) must create its own proposal . Congress must consider this proposal under special rules. Congress cannot consider any amendment to the proposal that does not achieve similar cost reductions unless both houses of Congress, including a three-fifths super majority in the Senate, vote to waive this requirement. If Congress fails to adopt a substitute provision by August 15, DHHS must implement the proposal as originally submitted to Congress.[3]

With regard to IPAB's recommendations, the law says "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and co-payments), or otherwise restrict benefits or modify eligibility criteria."[4]

Membership and term of office

IPAB is composed of 15 members appointed by the President, subject to Senate confirmation. The Secretary of HHS, the Administrator of the Center for Medicare and Medicaid Services, and the Administrator of the Health Resources and Services Administration serve ex officio as nonvoting members.[5] In making the appointments, the President consults with the Majority Leader of the Senate concerning the appointment of three members; the Speaker of the House of Representatives concerning the appointment of three members, the Minority Leader of the Senate concerning the appointment of three members, and the Minority Leader of the House of Representatives concerning the appointment of three members.[6]

The first members appointed to the board will be divided into three staggered classes in order to ensure that their terms do not expire simultaneously. Five will be appointed for a term of 1 year, five will be appointed for a term of three years, and five will be appointed for a term of six years. All subsequent appointments will be made for six years. A member may not serve more than two full consecutive terms.[7]

Appointed members of the IPAB will include individuals with national recognition for their expertise in health finance and economics, actuarial science, health facility management, health plans and integrated delivery systems, health facilities reimbursement, and other providers of health services or related fields to provide a mix of professionals, a broad geographic representation, and a balance between urban and rural areas. IPAB members must include (but will not be limited to) physicians and other health professionals, experts in the area of pharmaco-economics or prescription drug benefit programs, employers, third-party payers, individuals skilled in the conduct and interpretation of biomedical, health services, and health economics research, and expertise in outcomes and effectiveness research and technology assessment. Members must also include individuals representing consumers and the elderly. Individuals who are directly involved in providing or managing the delivery of Medicare items and services may not constitute a majority of IPAB’s membership.

The President of the United States must establish a system for public disclosure by IPAB members of any financial and other potential conflicts of interest. No IPAB member may be engaged in any other business, vocation or employment.[1]

Members will be paid at a rate described in Level III of the Executive Schedule that determines pay for senior executive branch officials. As of 2010 this is $165,300 per year.[3]

Funding

$15 million has been appropriated for IPAB in 2012. Future funding for the agency will be based on this figure but adjusted for inflation.[3]

Legislative history

IPAB was created in response to criticism of the Medicare Payment Advisory Commission (MedPAC), a body with no regulatory power that advises Congress. Critics claimed that "hundreds of billions of dollars" in spending cuts were proposed by MedPAC but never acted upon by Congress.[8] On June 25, 2009, Senator Jay Rockefeller introduced the Medicare Payment Advisory Commission Reform Act of 2009, which would have changed MedPAC into an executive branch agency.[9] On July 17, 2009, the Obama administration submitted to Congress a similar proposal called the Independent Medicare Advisory Council Act (IMAC), which would have created an independent five-member executive council to make recommendations to the president.

From June 17 to September 14, 2009, three Democratic and three Republican Senate Finance Committee members met for a series of 31 meetings to discuss the development of a health care reform bill, including an independent board that the senators informally described as “MedPAC on steroids.” During this period, Senators Max Baucus (D-Montana), Chuck Grassley (R-Iowa), Kent Conrad (D-North Dakota), Olympia Snowe (R-Maine), Jeff Bingaman (D-New Mexico), and Mike Enzi (R-Wyoming), met for more than 60 hours, and their discussions established the principles upon which healthcare reform legislation was later passed.[10] The Senate Finance Committee included a provision establishing an independent Medicare advisory board in its health reform legislation, which passed the Senate on December 24, 2009.[11]

During the health care reform debate of 2009-2010 that ended with the passage of the legislation by the Democratic-controlled Congress, Republicans proposed striking provisions in the bill that would require Medicare cost control. While voting yes on the legislation in April 2010, one liberal congressman, Pete Stark (D-Calif.), said that the IPAB "sets [Medicare] up for unsustainable cuts" that will endanger the health of patients, and that he would "work tirelessly to mitigate the damage" the panel would cause.[12]

Political debate

IPAB supporters claim that lower per capita health spending in foreign countries that also enjoy superior average levels of health points to the possibility of reducing healthcare spending without harming patients. "In most [medical] resources we have a surplus," said Dr. David Himmelstein of Physicians for a National Health Program. "People get large amounts of care that don't do them any good and might cause them harm [while] others don't get the necessary amount."[13]

The Washington Post reported that Phil Roe (Republican-Tennessee) twice sponsored bills to eliminate IPAB. Roe was described as a "magnet during the last election for more than $90,000 in contributions from medical professionals from across the country" and known as "a kindred soul by the medical industry" as a result.[14][15] Roe charged the IPAB would deny care. In reality, the rules governing IPAB explicitly bar 'any recommendation to ration health care.'[16]

Some Obama administration officials had feared the IPAB could be "target for attacks of the 'death panel' sort".[17]

According to The New York Times, the Pharmaceutical Research and Manufacturers of America has said that elimination of the payment board is its top priority in the 2011 Congress. The American Hospital Association and the American Medical Association have spoken out against the board.[18]

Congressional Budget Office scoring

The Congressional Budget Office (CBO) estimated that IPAB will achieve Medicare spending reductions of $15.5 billion over its first five years of operation. This amounts to 0.5% of projected Medicare spending for that period.[19] Through 2019, the IPAB is projected to effect cost savings of $28 billion.[16]

Fiscal commission report

The presidential commission report on reducing the federal deficit voted to strengthen the IPAB 11 to 7. It wished bring forward the time by which health care providers would be affected by IPAB decisions.[20][21][22][23] Specifically, the recommendations "would hit hospitals the hardest, which gained an exemption from the group’s decisions for several years".[24]

References

  1. ^ a b c Independent Payment Advisory Board American Medical Association. Quote|"By Jan. 1, 2015, and at least every other year thereafter, the IPAB will submit recommendations to slow the growth in national health care expenditures while preserving or enhancing quality of care."
  2. ^ consolidated bill Sec. 3403\1899A SSA page 409
  3. ^ a b c d Timothy Stoltzfus Jost. “The Independent Payment Advisory Board.” The New England Journal of Medicine. (May 26, 2010).
  4. ^ 111 Stat. 490; to be codified at 42 U.S.C. § 1899A(c)(2)(A)(ii).
  5. ^ 111 Stat. 502; to be codified at 42 U.S.C. § 1899A(g)(1)(A).
  6. ^ 111 Stat. 503; to be codified at 42 U.S.C. § 1899A(g)(1)(E).
  7. ^ 111 Stat. 503; to be codified at 42 U.S.C. § 1899A(g)(2).
  8. ^ Mike Lillis. “GOP leaders push to repeal Medicare cost-cutting panel.” The Hill. (July 28, 2010).
  9. ^ S. 1380
  10. ^ "Health Care Reform from Conception to Final Passage". Retrieved November 23, 2010.
  11. ^ See generally Stockdale (2010).
  12. ^ Julian Pecquet. “GOP staffer: Look to healthcare debate for repeal clues.” The Hill. (October 19, 2010).
  13. ^ James Ridgeway. “Meet the Real Death Panels.” Mother Jones. (July/August 2010).
  14. ^ R. Jeffery Smith Health-related money continues to flow to members of Congress The Washington Post. February 6, 2011.
  15. ^ Dr. Roe Introduces Legislation to Eliminate the Independent Payment Advisory Board: HR 452 – The Medicare Decisions Accountability Act Press Release. January 26, 2011.
  16. ^ a b Suzy Khimm (January 27, 2011). "It's Alive! GOPers Resurrect 'Death Panels'". Mother Jones. Retrieved February 8, 2011.
  17. ^ Jackie Calmes (April 17, 2010). "After Health Care Passage, Obama Pushes to Get It Rolling". The New York Times.
  18. ^ Duff Wilson "Industry Aims at Medicare Board" The New York Times. November 4, 2010.
  19. ^ The Effectiveness of IPAB, by Roger Collier, The Health Care Blog, 6 July 2010
  20. ^ Erik Wasson. “Rep. Ryan says deficit reduction plan would ‘entrench ObamaCare’” The Hill. (December 2, 2010).
  21. ^ The National Commission on Fiscal Responsibility and Reform. The Moment of Truth, at 41. Dec. 2010.
  22. ^ Derek Thompson, "The Plan to Balance the Budget: The Fiscal Commission's Final Report." The Atlantic. (December 1, 2010).
  23. ^ Ezra Klein. “The best and worst of Simpson-Bowles.” The Washington Post. (December 3, 2010).
  24. ^ Mathew DoBias. “Deficit Panel Offers Partial Answer on Health Care.” National Journal. (December 1, 2010).
Retrieved from "https://en.wikipedia.org/w/index.php?title=Independent_Payment_Advisory_Board&oldid=416822967"