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Is there a Doc-Fix for IPAB?

Congress has delayed a scheduled cut to doctors’ Medicare reimbursements for another year as part of the Fiscal Cliff Agreement.  Fearing the consequences if payments to doctors for Medicare services were cut by almost 27%,  Congress put off, for the 10th year in a row, the implementation of the Sustainable Growth Rate (SGR).  This annual rite of crisis management has come to be called the “doc-fix”.  Given the yearly  congressional consensus in executing this  ‘doc-fix’, why would Congress then pass the Accountable Care Act (ACA) which calls for similar provisions to cut doctor’s reimbursements?

The SGR is a payment adjustment formula devised in 1997 to reduce Medicare expenses.  The first decrease in 2002, 4.8%,  was met with such an outcry that Congress has delayed any further implementation ever since.  Now, a decrease of 26.5% is being called for and Congressional leaders fear that a cut that large would force doctors to stop accepting Medicare patients.  This is already happening with Medicaid where less than 42% of primary doctors accept Medicaid patients because of the low reimbursement rates.  Visions of angry seniors crowding hospital emergency waiting rooms in want of basic medical care has been enough for these ‘doc-fix’ measures to pass through Congress for the past 10 years.

But wait a minute!  Most of these same congressional members voted for the ACA which calls for a 15 member panel of government appointees to do exactly what the SGR provides.  Based on another formula, this board, the Independent Payment Advisory Board (IPAB) will lower the amount paid to doctors for Medicare services in order to keep government health care costs down.

To prevent Congress from doc-fixing these reductions, the law makes it nearly impossible for Congress to change IPAB decisions or remove the board.  Moreover, according to the law, the board and its decisions are not even subject to judicial review.

Richard Foster, respected Medicare actuary, verified the provision would result in disaster.  He testified before the law was passed that the rate reductions called for by the law’s formula are so great that seniors depending on Medicare services will be seriously harmed.  Doctors, nurses and laboratories, he said, would simply stop accepting Medicare patients;  and hospitals and nursing homes will go out of business.

So the situation we have is strange indeed.  We have a majority in Congress that agrees, year after year, that the implementation of a large Medicare reimbursement rate reduction would result in great harm.  Next we learn from congressional experts that this SGR provision cannot be permanently disengaged until Congress finds another $30 billion to take the place of the savings it should provide.  But it’s never provided $30 billion because it’s always been delayed.

And now we have the Independent Payment Advisory Board whose sole job is to keep Medicare costs down by reducing the amounts paid to doctors for their services.  The same people who prevent Medicare rate reductions with their annual doc-fix because of the harm it would cause, are most of the same people who voted for the ACA with its IPAB.  These same people insured that great harm would result by making it near impossible to change this part of the law.   Have we fallen down a rabbit hole and under the auspices of the Mad Hatter?  Or should I give our congressional representatives the benefit of the doubt and say they somehow missed that part of the 2800 page law they were supposed to read?


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