1. What is IPAB? IPAB is to be composed of 15 health care "experts" including physicians and "other providers", those "with expertise in health finance and economics… health facility management, health plans (insurance companies)"…consumer advocates, etc. Practicing physicians are not allowed to serve on IPAB. Health care providers cannot constitute a majority of IPAB.
2. How does this all work? IPAB's only function is to keep Medicare spending growth below an artificial rate (change in GDP + 1%). If Medicare spending exceeds this target, IPAB is instructed to propose cuts to reduce spending without affecting quality of care or coverage (benefits) for Medicare patients.
3. What can and can't IPAB do? By law, IPAB is not allowed to "ration health care, raise revenues or Medicare beneficiary premiums, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria." IPAB also cannot reduce reimbursement to Medicare Part A (hospitals and nursing homes) until after 2020.
4. What exactly will IPAB do? When IPAB is asked to reduce Medicare costs without reducing benefits, increasing premiums, or making reimbursement cuts to hospitals or nursing homes, it seems the only option left will be to cut physician reimbursement. Unless Congress provides for an equal amount of cuts elsewhere in the budget, or vetoes the IPAB plan with a supermajority (60 votes in the Senate), IPAB's recommendations will become law.
5. How does this affect our patients? Cutting reimbursement to physicians will lead to fewer physicians accepting Medicare patients, and thus decreased access to health care. This will lead to more visits to emergency departments which will exacerbate the crowding plaguing many of our EDs. According to a recent study, the number of physicians who no longer accept Medicare patients increased from 4.5% to 7.1% over just 3 years (2005-2008)[ii] and many other physicians no longer accept new Medicare patients. The bottom line: Cutting physician reimbursement hurts patients' ability to access quality health care.
6. How does this affect emergency physicians? Unlike other physicians, who may stop accepting Medicare patients and thus stop participating in the Medicare program, emergency physicians are obligated to stabilize and treat all patients (under the EMTALA law of 1986) with no promise of fair reimbursement. When other primary care and specialty physicians stop accepting Medicare patients, those patients will arrive in the ED with nowhere else to turn. Our EDs will become overcrowded, and likely more dangerous, as studies have shown that crowding increases mortality[1]. Both patients and physicians will lose. Any harm done by IPAB will only exacerbate the payment cuts and freezes from the flawed SGR formula that already underpays physicians, with a 29.5% cut in Medicare reimbursement expected on January 1, 2012. The safety net of our health care system will become further strained, emergency physicians will be severely underpaid, access to health care will diminish, and quality of care will suffer.
7. The politics behind it: There is bipartisan support for repealing the IPAB. As of September 21, 2011, 194 Republican and 11 Democrat members of the House of Representatives support repealing IPAB; 32 Senators (all Republicans) have cosponsored a similar bill in the Senate.
8. Can't we just wait until IPAB starts to see what happens? Once IPAB reduces physician reimbursements, by law, reversing those cuts will require making equal cuts elsewhere in the federal budget to offset the money owed to physicians. This situation would be even more taxing than our constant efforts to lobby Congress to retroactively fix the flawed SGR reimbursement formula.
9. Other problems with IPAB: The majority of IPAB members cannot be health care providers. This requirement is illogical. Who is in a better position to evaluate medical and financial implications to patients and physicians better than the physicians who are in the trenches?
10. Why shouldn't Medicare spending increase? This year marks the beginning of Medicare eligibility for 78 million baby boomers. Given that the number of people Medicare will cover over the next 10+ years will skyrocket and health care costs will naturally and expectedly increase, placing an artificial limit on Medicare spending (as IPAB does) is inconsistent with the demographical changes and needs of our society.
11. No checks & balances. The entire government is designed to function in a system of checks and balances to ensure accountability. IPAB has no checks or balances. There is no real accountability to the actions of these unelected IPAB bureaucrats. Allowing this IPAB board to rule is tantamount to Congress abdicating its powers and responsibilities to the Executive branch (as it is the President who appoints these members). Furthermore, members could theoretically be appointed during a recess, bypassing the Senate confirmation process.
12. Solution: ACEP and other medical organizations oppose the creation of IPAB. Call or email your member of Congress asking them to repeal the IPAB. Ask members of Congress to cosponsor HR 452 and Senators to cosponsor SB 668.
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