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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Independent Payment Advisory Board IPAB (IPAB)

Established in Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152), the IPAB—a 15 member independent panel, to be appointed by the president and confirmed by the Senate— is charged with enforcing a limit on Medicare spending growth.  IPAB members are expected to be nationally recognized experts in health finance, payment, economics, actuarial science, or health facility and health plan management.  The board will have broad authority to craft and execute new Medicare policies (including changes to provider reimbursement) with limited Congressional input.  In general, unless Congress acts to block the proposals within a brief and limited time period and identify similar savings elsewhere, CMS will implement the policy recommendations.  The first IPAB proposal must be submitted to Congress and the president beginning in 2014.  The IPAB is expected to save $15.5 billion over 10 years.  Additional information on this provision has not yet been published. 


In opposition to the IPAB, Senators John Cornyn (R-Texas), Orrin Hatch (R-Utah), Jon Kyl (R-Ariz.), Pat Roberts (R-Kan.), and Tom Coburn (R-Okla.) July 27 introduced the “Health Care Bureaucrats Elimination Act” (S. 3653), which would repeal the IPAB.  In a joint statement, Senator Cornyn said the IPAB would “put power in the hands of politically-appointed Washington bureaucrats.”  Senator Roberts added the IPAB will lead to rationing and that access to quality care will be “threatened by the decisions made behind closed doors by an unelected board and unaccountable government officials.”  Similar legislation, the “Medicare Decisions Accountability Act of 2010” (H.R. 4985), was introduced March 25 in the House by Representative David Roe (R-Texas).  As of August 30, S. 3653 had 11 co-sponsors and H.R. 4985 had 54 co-sponsors.   


The AAMC continues to believe that the Medicare Payment Advisory Commission (MedPAC), as currently structured, already serves as an independent advisory body to Congress.  The AAMC also believes Congress should continue to exercise its ability to evaluate the impact of payment policy changes on the communities and patients they serve. 


During debates over health care reform, the AAMC joined 73 health care provider and advocacy groups in signing a January 11 letter to Senate Majority Harry Reid (D-Nev.) and House Speaker Nancy Pelosi (D-Calif.) strongly opposing the establishment of the IPAB in the final health care reform agreement.  The letter states that, in addition to the savings in provider payments already included in the health reform legislation, the IPAB reductions could “jeopardize both access for Medicare beneficiaries and even infrastructure for the entire health care system.”  The letter is available at:    


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