Independent Payment Advisory Board foes press for repeal

Urologists who came to Washington in March to let Congress know their concerns about key regulatory issues had a big target in mind-killing the Independent Payment Advisory Board, created by the new health care reform law as a way to reduce Medicare costs.

The intensity of their concern about the implications of the IPAB and the power it will have over physician fees was clear as key congressional aides discussed the IPAB during the Joint Advocacy Conference (JAC) sponsored by the AUA and the American Association of Clinical Urologists.

Kevin Loughlin, MD, professor of surgery at Harvard Medical School, Boston, called the rationale for IPAB given by one legislator's aide "one of the most frightening things that I've heard in quite a while."

Dr. Loughlin's point was that the power given the IPAB by Congress to take action designed to cut Medicare spending runs counter to the system of checks and balances on which the U.S. government is based.

"Where does it stop?" he asked. What if the president appointed such a board to set defense policy, he wanted to know.

"We lose the essence of what the whole issue of citizenship is about," Dr. Loughlin said to the applause of his peers in the audience.

Dash was there to explain why the IPAB had been included in the Affordable Care Act, a provision that was spearheaded by her boss. The Congressional Budget Office has estimated that creation of the IPAB, which is to begin implementing cost-cutting recommendations in fiscal year 2015, will save some $15.5 billion by 2019 and more after that, helping to bring Medicare inflation under control.

"What are some of the alternatives to the IPAB?" Dash asked. "The status quo is not an alternative. The Medicare Trust Fund was expected to run out in 2014. Now, it is 2029. Anything we do to repeal the Affordable Care Act or the IPAB affects that. We can't just stick our heads in the sand and pretend that Medicare is going to go on forever if we do nothing. IPAB will not cut benefits or increase cost sharing, unlike other proposals out there. And, the board has a mandate to improve the quality and delivery of care."

The AUA points out that the new board consists of 15 members to be appointed by the president, fewer than half of whom can be health care providers and none of whom can be actively practicing physicians. The only way Congress can block the IPAB's cost-cutting measures would be to pass a joint resolution.