U.S. CONGRESSMAN PHIL ROE, M.D. 1st. District of Tennessee

Washington, Jun 23, 2010 - Tucked away in the 2,000-plus pages of the health care law is a provision that would create a harmless-sounding entity called the Independent Payment Advisory Board (IPAB). Its job, as laid out in the law, would be to enact savings from the Medicare program when actual spending exceeds targeted spending levels. It doesn't sound like something to be too concerned about, right? If you're a senior or a physician, you should be.

For comparison, consider what has happened with Medicare physician payments. In 1997, Congress enacted a formula called the sustainable growth rate to set physician payments under Medicare. The formula works very similarly to the IPAB: If physician payments exceed a targeted spending level, the per-procedure payment is cut to bring the spending levels back in line with the target. When it was created, it was believed the formula would help ensure that physicians would continue to see adequate payment for their work because they could simply do more procedures. Instead, physicians have gotten a decade-plus of proposed cuts that they have had to ask Congress to stave off. Recently, a 21 percent cut went into effect for just less than a month, so these cuts aren't an idle threat.

After this experience, you would think Congress would think twice about putting the power to set Medicare rates in the hands of an unaccountable board whose sole job is to make care decisions on the basis of a budget. But that's exactly what the recently passed health care law does. The IPAB's sole intention will be to determine whether Medicare is spending more than is budgeted and, if so, to make cuts that then will be fast-tracked with very little opportunity for congressional input. In effect, with the creation of this board, Congress has ceded much of its authority to oversee Medicare.

This board does not have a mandate to improve patient care - it has a mandate to meet a budget, and that harms patient care. Period. In the past, such boards have looked to cut physician payments first, and then, when physicians stop covering the services, they cut back on the number of procedures that are allowed. Fortunately, previous boards have made nonbinding recommendations. Some recommendations Congress adopts, others it doesn't, but at least the decisions are reviewed. Now, all recommendations - flawed or otherwise - will be fast-tracked to become law.

Great Britain's medical system has a comparable board, known as the National Institute for Health and Clinical Excellence - or NICE. Unfortunately, this board's effect on health care for seniors is anything but nice. In one of its most recent decisions, the NICE board denied approval for a breast cancer drug that helps treat late stages of the disease, citing the high cost and what it deemed to be an insufficient benefit. The drug prolongs life an average of 10 weeks.

Ten weeks. To someone sitting behind a desk who is not dealing with the realities of cancer, it's easy to think 10 weeks is not a lot of time - particularly for a drug that "only" impacts an estimated 2,000 people. But if you're someone who has cancer or a family member of someone who does, it doesn't matter what the statistics say about a patient's chances - the chance of getting the cancer is 100 percent, and you want to do all you can to fight it.

This type of decision is precisely the type of decision the IPAB will be charged with making. And if our experience with spending targets in physician payments is any indication, there will be a lot of cuts and denials of care. This simply can't be allowed to happen.

We have bipartisan agreement around the idea that unelected bureaucrats shouldn't be able to make unaccountable decisions. Therefore, I've introduced legislation to repeal the provision creating this board, with a number of Republicans and 50 Democrats expressing in a letter their opposition to creating this board as well. It's time we act and repeal this provision before the board makes a decision that can't be reversed.