Of all the provisions of the Affordable Care Act (ACA), probably the 2nd most controversial one after the individual mandate is the IPAB (Independent Payment Advisory Board). IPAB creates a board of 15 members that could set payment rates for Medicare services. The members all get paid a government salary and can have NO other outside work. The rates they set do not have to be approved by Congress and the IPAB doesn’t have to have any physicians—or patients—as members. Its cost-cutting proposals must be implemented unless Congress adopts alternative proposals achieving equivalent levels of savings.

The ACC had a tremendous opportunity this week to be invited to testify at the House Energy & Commerce Committee hearing on IPAB. What an opportunity!

First and foremost, I told the committee that the ACC fully supports the purpose of IPAB. It is essential to get health care cost increases reined in to protect national, personal and business affordability! Early in the health reform debate, the College hoped the IPAB concept would evolve into an opportunity to break down the silos of parts A and B in Medicare and modernize the program by focusing on quality improvement.  Our problem is that the current structure of IPAB will not do that, and will have many unintended and negative effects on health care. It will save no money through price controls but it will reduce access to care for lower-income people, and will negatively affect all Medicare beneficiaries’ access to high-quality care.

The basic gist of my testimony was that significant modifications are necessary. Preferably scrap the IPAB, or amend the heck out of it into something that adds value was my message. The ACC believes IPAB must place more emphasis on payment reforms that improve quality and lower costs rather than price controls that could hurt access—and as history proves—won’t work.

Furthermore, the ACC believes that Congress must first act to permanently repeal the flawed sustainable growth rate (SGRrrr) formula used to set Medicare physician payment rates prior to contemplating the IPAB “fix.” Physicians are already subject to an expenditure target and other potential payment reductions as the result of the SGR. It doesn’t make sense to subject physicians to expenditure targets while at the same time exempting from IPAB’s recommendations large segments of Medicare providers who are subject to no target at all. Until the SGR is replaced, the ACC cannot support implementation of IPAB---which first must be amended to be something different and effective.

There’s a video of the hearing on YouTube (embedded below). Unfortunately, while my voice carried well, my microphone was off while I was giving my testimony. Check out 4hr:20min recording point for the question-and-answer session, where I fielded questions from several committee members with the microphone actually working.

During the Q&A, I had the opportunity to emphasize ACC’s support for the Center for Medicare and Medicaid Innovation and highlight the quality improvement initiatives underway at the ACC, including the PINNACLE Registry. My written testimony is on CardioSource, but I departed from it significantly to be more emphatic and respond to issues raised by other testifiers.