OK. It’s getting close. Finally, some of the real provisions of the health insurance reform act passed last year are going to come into view. One of the first things that will make a difference- a big one- is IPAB. No, it’s not an Apple product. It stands for Independent Payment Advisory Board. What is does is something pretty special- it will put the brakes on Medicare spending, should the costs rise too quickly and too high.
IPAB will make recommendations. They will become law unless Congress acts to override their recommendations. But, not just any override. Congress will have to come up with cuts that will match the dollar amounts that IPAB developed by August of each fiscal year. No action- they happen anyway. It’s a way to make things happen and not languish.
The IPAB will be comprised of 15 members. 12 are jointly chosen by the President and BOTH parties. 3 are solely at the discretion of the President. All members must be confirmed by the Senate (hopefully, in less than a year). The term of office is six years. They can hold NO OTHER jobs, and will be paid $ 165K or so.
There is a problem in that hospitals and nursing homes will not be directly affected by this provision until 2020. So, for the first five years, only doctors and drug companies will be subject to these provisions. (I won’t go into the political considerations and/or the desire to find a way to overturn this law without really overturning it.)
Right now, the CBO (Congressional Budget Office) does not see the need for the IPAB to make any actions prior to 2020. Of course, there is no guarantee. Moreover, there are some that want the targets to be dropped by ½ %, which would definitely cause the IPAB to make recommendations.
Some will tell you that this could turn into a “death panel”. However, this panel is identical in concept to plans many states use. (You can read about the Oregon Plan and “death panels”, here.) And, if we want to limit the rampant growth in our health costs, we have two options. This is one. The other is to drop “pay per visit” and switch to “pay for performance” for physician and hospital reimbursement.
And, while we’re at it..lets talk about the Patient-Centered Outcomes Research Institute (POCRI). POCRI is the group that will manage comparative-effectiveness health research. If you believe (as I do that 15 to 30 % of all health care is wasted (there is a 2009 article by Atul Gawander that claims so in the New Yorker- not the greatest research, but certainly food for thought), then you know what POCRI does will be critical to our future. When they succeed, we will save a bundle and our health care spiral will attenuate. To insure their success, Dr. Joe Selby has been named executive director. His credentials are impressive. He is an MD/MPH (Masters in Public Health), the director of research at Kaiser Permanente NoCal for 13 years, a professor at UCSF, a visiting prof at Stanford…He was elected to the Institute of Medicine (2009), got his MD from NorthWestern and his MPH from UC Berkeley. He was a PHS (Public Health Service) officer from 1976 to 1983. I guess he’s not such a nameless bureaucrat, after all…
I was asked by a few people to explain “Pay for Performance” (P4P). For those of you on Facebook, you can find the information (and can discuss this article) here.
