IPAB’s Medicare cuts will threaten seniors’ access to care

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As Congress begins to debate the future of the Affordable Care Act (ACA), there is no doubt that the American people will hear a lot of rhetoric regarding changes in the ACA affecting Medicare.  

However, there is one fact that cannot be overlooked even before the first repair or replacement bills are rolled out: significant Medicare cuts loom just around the corner, threatening seniors’ timely access to vital healthcare services.

{mosads}Why? Because for the first time since its inception in 2010, experts anticipate that growth in Medicare spending will exceed annual spending targets, thus triggering mandatory spending cuts by the Independent Payment Advisory Board or IPAB.


As a neurosurgeon who treats Medicare patients, I consider the IPAB to be one of the most insidious elements of the Affordable Care Act (ACA), and it needs to go.

Since Medicare’s inception, Congress has led the way in shaping policies to ensure our seniors’ healthcare needs will be taken care of.

We saw this in the last Congress with a major overhaul of Medicare’s payment system — now known as MACRA — pass with strong bipartisan majorities and then get signed into law by President Obama.  

This is how Medicare policy is supposed to work. Now however, with the advent of IPAB, the people’s elected representatives will no longer have power over Medicare payment policy. Instead, these major health policy decisions will rest in the hands of 15 unelected and largely unaccountable bureaucrats, with little or no clinical expertise or the oversight required to protect access to care for our country’s seniors.

And they will only have one job: to cut billions of dollars from Medicare. Even worse, if no board is appointed, which is the situation right now, the Secretary of Health and Human Services has the sole authority to make these decisions.

Specialty physicians recognize that we need to control the growth of healthcare spending, but the IPAB is simply the wrong solution for addressing these budgetary challenges. 

Operating now under MACRA, physicians have plunged into the nascent value-based payment world, which, if implemented correctly, will not only improve healthcare quality but will also drive down Medicare costs.

Rather than this thoughtful approach to cost containment and quality improvement to enhance the value of the Medicare program, the IPAB is a merely blunt instrument to reduce what Medicare pays for medical treatments and will bring progress on value-based care to a screeching halt.

Having lived through a similarly flawed Medicare payment system — the sustainable growth rate or SGR formula — for more than a decade, the last thing we need is another rigid system that relies solely on payment cuts to control Medicare spending.

So, in the end analysis, arbitrarily ratcheting down provider reimbursement, without sufficient oversight and without care taken to ensure that Medicare beneficiaries receive the quality healthcare that they need and deserve, is this the wrong medicine for fixing our ailing healthcare system.

And Americans agree. According to a recent Morning Consult poll, voters oppose changes that would limit access to care, with the vast majority of adults putting their trust in doctors (84 percent), rather than government officials (4 percent) or members of Congress (three percent), when it comes to medical treatment decisions. Furthermore, more than half of our seniors (56 percent) say allowing IPAB to make changes to Medicare will hurt the quality of Medicare services.

Fortunately, it looks as if Congress is paying attention. In rare bipartisan fashion, legislation to repeal IPAB has been introduced by Sens. John Cornyn (R-Texas) and Ron Wyden (D-Ore.) in the Senate, and by Reps. Phil Roe (R-Tenn.) and Raul Ruiz (D-Calif.) in the House of Representatives.

The Alliance of Specialty Medicine — representing more than 100,000 medical specialists and their patients — is urging lawmakers to expedite action on this issue.

As a nation, we have promised our seniors a Medicare system that offers the best care in the world. Bringing an end to the IPAB once and for all is a vital step to fulfilling that promise.

Alex B. Valadka, MD, is a neurosurgeon at Virginia Commonwealth University and a spokesperson for the Alliance of Specialty Medicine.

The views expressed by contributors are their own and are not the views of The Hill.

Tags Health Healthcare John Cornyn Medicine Ron Wyden

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