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June 13, 2011
Dear Member of Congress:
The organizations listed below represent a breadth of entities including all sectors of the healthcare industry, employers of different sizes and geographic locations, as well as purchasers of care, consumers and patients.  We all share the conviction that the Independent Payment Advisory Board (IPAB) will not only severely limit Medicare beneficiaries’ access to care but also increase the cost of care that is shifted onto the private sector.  While we all recognize the need for more sustainable healthcare costs, we do not believe that IPAB is the way to, or will, accomplish this goal.
As you know, the Patient Protection and Affordable Care Act (PPACA [P.L. 111-148]) created the IPAB, a board appointed by the President and empowered to make recommendations to cut spending in Medicare if its spending growth reaches certain measures.  The IPAB will have unprecedented power with little oversight, even though it has the power to literally change laws previously enacted by Congress.  Further, the law specifically prohibits administrative or judicial review of the Secretary’s implementation of a recommendation contained in an IPAB proposal.
We are deeply concerned about the impact the IPAB, as structured, will have on patient access to quality healthcare.  Because of the way in which the board is designed, the bulk of any recommended spending reductions will almost certainly come in the form of payment cuts to Medicare providers.  This will affect patient access to care and innovative therapies. In the past five years for which data is available, the number of physicians unable to accept new Medicare patients because of low reimbursement rates has more than doubled.  According to an American Medical Association survey, current reimbursement rates have already led 17 percent of all doctors, including 31 percent of primary care physicians, to restrict the number of Medicare patients in their practices.  In all likelihood, the IPAB will only exacerbate this problem.
While we are all supportive of improving the quality of care in this country, we are concerned that the IPAB, as structured, will not be able to focus on improving healthcare and delivery system reforms, as some of its proponents have suggested.   Requiring the IPAB to achieve scoreable savings in a one-year time period is not conducive to generating savings through long-term delivery system reforms.  According to a recent Kaiser Family Foundation issue brief, “[w]hile the requirement to achieve Medicare savings for the implementation year provides a clear direction and target for the Board, it may discourage the type of longer-term policy change that could be most important for Medicare and the underlying growth in health care costs, including delivery system reforms that MedPAC and others have recommended which are included in the ACA – and which generally require several years to achieve savings.  If these delivery system reforms are not ‘scoreable’ for the first year of implementation, the IPAB may be more likely to consider more predictable, short-term scoreable savings, such as reductions in payment updates for certain providers.”  The Congressional Budget Office (CBO) has in fact stated that the Board is likely to focus its recommendations on changes to payment rates or methodologies for services in the fee-for-service sector by non-exempt providers.  Again, this will have a severe, negative impact on Medicare beneficiaries.
Last, we believe that the IPAB sets a dangerous precedent for overriding the normal legislative process.  Congress is a representative body that has a duty to legislate on issues of public policy.  Abdicating this responsibility to an unelected and unaccountable board removes our elected officials from the decision-making process for a program that millions of our nation’s seniors and disabled individuals rely upon, endangering the important dialogue that takes place between elected officials and their constituents. 
We do not believe the IPAB is the right way to achieve savings in Medicare and strongly urge Congress to eliminate this provision. 

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