Why the independent payment advisory board is a good idea

The independent payment advisory board (IPAB) is a key feature of the ACA. This board will do what many countries already do — have an independent expert panel to assess the effectiveness of procedures, imaging studies, pharmaceuticals, etc.

Why do we need this board? We need careful assessments of new trends in medicine.

Let me suggest two situations.

We have read much about increasing colonoscopy costs. We have a controversy about anesthesia — conscious sedation versus a more standard anesthesia with propofol. The former only requires the gastroenterologist; the latter adds an anesthesiologist, and therefore another huge bill. What should Medicare pay for colonoscopy, and should they pay for the anesthesia?

A new drug is developed for lung cancer. It costs 10 times standard therapy. Oncologists and the pharmaceutical company both make more money from using this drug. How do we determine its worth? This question is hypothetical but very similar to situations that we see for many pharmaceuticals.

Here is a quick list of issues I would want advice on:

  • routine screening for aortic aneurysm at age ??
  • colonoscopy for colorectal cancer screening after 2 normal colonoscopies
  • interval for repeat echocardiograms
  • criteria for starting home oxygen in COPD or restrictive lung disease (Medicare uses < 89% oxygen saturation, VA uses < 92%)
  • first line antibiotics for MRSA
  • firm criteria for artificial joints

What is your list?

Note that the IPAB can recommend payment decisions, but that Congress can overrule. This board will create some controversies, but we must contain costs. We can only do that through choosing wisely about health care expenditures. We need a group of independent experts to provide such decisions and the rationale for those decisions.

IPAB is a good idea.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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  • Ron Smith

    Hi, Robert.

    I’m sorry, but the terms ‘independent’ and ‘advisory payment board’ are not compatible with the laws of physics and politics in this universe.

    That’s because ‘people’ do the ‘advising’ on these boards and we can assume that the chances of finding someone who does not lean strongly one way or another on Obombacare is about as frequent as actually detecting neutrinos in deep cavern water pool sensors.

    More schilling for this disastrous monstrosity is like lipstick on pig and is just as worn out as that cliche.

    Respectfully,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • Dr. Drake Ramoray

      “Of all tyrannies a tyranny sincerely exercised for the good
      of its victim may be the most oppressive. It may be better to live
      under robber barons than under omnipotent moral busybodies.
      The robber baron’s cruelty may sometimes sleep, his cupidity may
      at some point be satiated, but those who torment us for our own good
      will torment us without end for they do so with the approval
      of their own conscience.”

      CS Lewis.

      • Ron Smith

        Hi, Drake!

        I’m a HUGE fan of C. S. Lewis. He lived in the time of the British National Health Service and no doubt experienced then what we are going through now. I agree totally!

        Warmest regards,

        Ron Smith, MD
        www (adot) ronsmithmd (adot) com

  • Dr. Drake Ramoray

    “Of all tyrannies a tyranny sincerely exercised for the good
    of its victim may be the most oppressive. It may be better to live
    under robber barons than under omnipotent moral busybodies.
    The robber baron’s cruelty may sometimes sleep, his cupidity may
    at some point be satiated, but those who torment us for our own good
    will torment us without end for they do so with the approval
    of their own conscience.”

    CS Lewis.

    • KMarton

      There’s nothing in the IPAB paw that implies price controls. You’re the one who’s being misleading. IPAB will more likely recommend ways to redcue costs by improving efficiency and cost-effectiveness.

      • Dr. Drake Ramoray

        You are incorrect. From the Center for Budget and Policy Priorities which supports the ACA and IPAB.

        “For example, the law authorizes IPAB to recommend changes in relative payment amounts for different forms of care. IPAB could propose higher payments for treatments and prevention activities that are found to be more cost-effective. Such changes would not restrict the choices of either physicians or beneficiaries, but they could prompt both providers and patients to pay more careful attention to the latest research findings.[12] IPAB could also recommend payment methods that would reward providers for quality and efficiency and offer incentives for consumers to choose more efficient providers or procedures.[13]”

        http://www.cbpp.org/cms/?fa=view&id=3702

        Prices up, prices down, doesn’t really matter. Price controls.

        • KMarton

          Here’s the definition of price controls, and it’s not what you are suggesting. http://www.investopedia.com/terms/p/price-controls.asp
          However, what you are suggesting is exactly what the government has done for years. Medicare has for some time declared what it will pay for care. This is no different, so if you’re suggesting that what the IPAB will do is different, then think again.

  • fatherhash

    so what would be a good alternative to IPAB?…..since a blank check for anything and everything also isn’t possible.

  • KMarton

    So far, that has not succeeded very well, if at all. Perhaps if doctors and patients had more real-time information about the true costs and benefits of each decision and if the physicians were not subject to enticements from vendors, THEN this approach would work better. .

  • fatherhash

    no problem with that….but who pays?

    when i’m in a room with my pt, there is no one else in there making decisions except for me and my patient. we get to decide what meds and tests we want. but it becomes a problem when we try to get others(3rd party) to pay for it.

    unless, of course, you feel that 3rd party should pay for whatever i order whenever i order it without question.

  • Michael Wasserman

    I think that the bottom line is that Medicare is essentially dictated by the AMA, Pharma, the insurance industry and the American Hospital Association. The system doesn’t run based on free market forces and continues to move in the wrong direction. The IPAB was an attempt to force changes on the present system. The problem with it is that it’s going to be a purely political body. Since when have Presidential Commissions, Committees, Advisory Boards, etc., not been made up with politically oriented appointees? If this was truly a panel of experts that consisted primarily of physicians and other health care providers who understood what is wrong with our present system, it might have a chance of working. But, let’s not fool ourselves or anyone else, that is not how people will be chosen for the IPAB. In the end, it won’t help.

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