ENTtoday

IPAB is Medicare’s New Hammer for Spending Accountability

by Christopher Guadagnino, PhD •

On Feb. 29, the Health Subcommittee of the House Energy and Commerce Committee held a meeting to consider H.R. 452 and voted 17 to 5 to favorably report the bill out of committee. The top-ranking Democrat on the subcommittee and one other Democrat voted for the measure, along with all 15 Republicans present.

Another supporter of H.R. 452, the American College of Surgeons, has long opposed the IPAB. David Hoyt, MD, FACS, ACS Executive Director, recently sent a letter supporting the repeal of the IPAB to the subcommittee’s chairman, warning that “leaving payment policy decisions in the hands of an unelected, unaccountable governmental body with minimal congressional oversight will negatively impact the availability of quality, efficient health care to Medicare beneficiaries and all Americans.”

The Real Cost Drivers

Besides urging repeal of the IPAB, the AAO-HNS also urges Congress to revisit the ACA to ensure that implementation efforts focus on reform provisions that genuinely improve quality and access to health care. According to Dr. Nielsen, the current economic situation is unsustainable and poses a looming crisis unless the rising cost of health care is addressed. Reform should drill down to the major locus of cost savings, which is not physician reimbursement, per se, he said.

“We have to accept responsibility to reduce costs on our own, and we know that reimbursement can no longer be entirely based on fee for service. But high quality, highly specialized tertiary care can only be sustained if it is reimbursed adequately,” Dr. Nielsen said.

If the whole purpose of mechanisms like the IPAB is to reduce the overall cost of health care, the most dramatic opportunities will not come from penalizing physicians who offer the most sophisticated, life-saving procedures, he said.

Instead, the focus should be on drivers of the highest disease and cost burdens, things such as end-of-life care, COPD and other chronic diseases, end-stage renal disease and preventable hospital readmissions, Dr. Nielsen said. “Successfully influencing these factors is where you dramatically shift costs,” he added.