Phil Roe

The Affordable Care Act (ACA) authorized the creation of the Independent Payment Advisory Board (IPAB). The IPAB will consist of 15 members, appointed by the president and confirmed by the Senate. The IPAB’s purpose is to limit growth in Medicare spending with mandates in effect unless expressly overturned through congressional action.

Nashville Medical News recently spoke with Congressman Phil Roe, MD (R-TN 1) regarding legislation he introduced, HR 452, Medicare Decisions Accountability Act of 2011. If passed, this legislation would eliminate the IPAB.

NMN: What are the problems you see with the IPAB?  Why did you introduce the legislation? 

Congressman Roe: Let’s start with the healthcare bill, the so called Affordable Care Act. The House version of the bill did not have the IPAB in it. Currently there is a group called MedPac, which is an advisory board to Medicare about how dollars are spent. Unlike the IPAB, MedPac is strictly an advisory board, it is not mandatory.

IPAB came in to being as a result of the Senate bill. The IPAB was not discussed in any House committee of jurisdiction: Energy and Commerce, Ways and Means, or Education and Workforce. There were more than 50 Democrats who signed a letter opposing the IPAB. Congressman Neal from Massachusetts was the lead author of the letter. Other congressmen such as Henry Waxman — a very liberal member from California — Pete Stark, Charlie Wrangle, and others signed on. I read it and totally agree with them.

What the IPAB is … the short and sweet of it … is a board of 15 bureaucrats who will determine, based on the amount of money spent, a ceiling of how many Medicare dollars are spent. The mandates will not be based on quality or outcomes, which are what physicians would want to look at. Physicians want to know what are the outcomes, and what is the quality of the care we’re getting. The IPAB has nothing to do with that. The IPAB lets Congress abdicate its responsibility. We had (Health and Human Services) Secretary (Kathleen) Sebelius consult our committee on Education and Workforce for two hours. I questioned her about IPAB. She’s all for it because it gives the bureaucrats and Congress cover when they ration care.

NMN: What do you think the chances are of H.R. 452 being successful in this Congress?

Congressman Roe: We started out about 6 to 8 weeks ago, and I could not get much traction for the bill … and the reason is that it is not easy to sound bite. An easy sound bite is: gas prices are too high, quit giving tax breaks to big oil companies so gas would be cheaper. But to explain to non-medical people the problems with the IPAB is difficult. So what I’ve been doing is going around one on one explaining this issue.

Our medical societies — dermatology, anesthesiology, obstetrics, neurosurgeons — have come by and said how can we help you Phil? I said the way you can help with this bill is to go to other congressmen and explain it to them so they can understand from a physician’s viewpoint how we think it will adversely affect our patients, so they’ve been doing that. We started off with about 8 or 10 congresspersons and today we just got our 100^th co-sponsor. We have Democrats on there, including some very liberal Democrats, and I think we will get more. The chances of it passing go up every day. I think we have a great shot to get it out of the House.

I’m more enthused than I ever have been about it, as we explain it and people understand the issue. It is also getting some traction in the Senate. Remember that the Senate election is just next year so it is not very long until that election … so I think it is good in the House and a possibility in the Senate. I think President Obama would veto it because it is the centerpiece of his legislation for affordable care; to hold Medicare spending down, and basically ration care. That is what this IPAB will ultimately do to our patients.

 Dr. Brent Moody is the founder and medical director of the Skin Cancer & Surgery Center, PLC in Nashville, TN. Dr. Moody is a Mohs Micrographic Surgeon and skin cancer specialist. He can be reached at brmoodymd@yahoo.com.

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