GOP wants new projections on Medicare cost-control panel

Washington Rep. Phil Roe, MD (R, Tenn.), one of the primary opponents on Capitol Hill of the Medicare Independent Payment Advisory Board, says current estimates of when the IPAB would be expected to act to curtail program spending are likely unrealistic.

On Aug. 28, Dr. Roe wrote to the Congressional Budget Office to ask for new projections on IPAB activity given that lawmakers consistently have countermanded scheduled pay reductions to physicians required by the program's sustainable growth rate formula. The advisory board was authorized under the Affordable Care Act to determine cost controls for the program when total spending exceeded set targets. Those controls could be implemented as early as 2015 — unless overridden by large majorities in both houses — but CBO estimates that it would be at least several years before spending reached the level where the IPAB would be compelled to act.

Rep. Phil Roe, MD (R, Tenn.)

Dr. Roe, however, indicated that those projections might not be accurate if Congress were to follow its historical path of approving legislation overriding SGR cuts before they kick in. Doing so would result in higher program spending than if the deep pay cuts were to take effect, but CBO typically follows current law assumptions when determining its cost projections.

In the letter to CBO, Dr. Roe asks for new projections on when and to what extent the IPAB would be required to come up with a Medicare spending reduction plan under three possible scenarios:

• Current physician payment rates are extended through 2013 before reverting back to the SGR formula.
• Current physician payment rates are extended through 2014 before reverting back to the formula.
• Current physician payment rates are extended indefinitely.

“I believe that the current score for the IPAB — established in March 2012 as part of the cost estimate for [an ACA repeal bill] — likely underestimates the impact that this unaccountable bureaucracy could have on Medicare spending given that Congress has enacted a 'doc fix' every year since 2003,” Dr. Roe wrote.

The House has voted several times to eliminate the IPAB provision as part of legislation repealing the entire health system reform law. The American Medical Association and other physician organizations supported the ACA's enactment but have called for the repeal of the IPAB, saying the board could result in even deeper cuts to doctor pay than the ones mandated by the flawed SGR formula.