Controlling the per capita rate of growth in Medicare spending: The Independent Payment Advisory Board, the Medicare Payment Advisory Commission, and Congress

The rate of growth in Medicare spending threatens Medicare's sustainability. The Patient Protection and Affordable Care Act (ACA) authorized the Independent Payment Advisory Board (IPAB) to help constrain growth in Medicare spending by making enforceable recommendations to Congress for controlling costs once growth rates are high enough to trigger the board's authority. IPAB's proposals cannot include recommendations to modify eligibility criteria, restrict benefits, raise beneficiaries' costs, or ration care. It can recommend health delivery system improvements to promote integrated care, care coordination, preventive practices, and evidence-based services. Congress has the option of coming up with its own ways to reduce the rate of growth of Medicare spending in compliance with the defined target growth rates. Only if Congress cannot come up with its own interventions will IPAB's recommendations be enforced. Those opposed to IPAB would repeal the establishment of IPAB, leaving in place the Medicare Payment Advisory Commission (MedPAC), an advisory commission for Congress. Opponents argue IPAB will drive down physician reimbursements, cause more physicians to opt out of serving Medicare beneficiaries, and decrease beneficiaries' access to care. Supporters of IPAB argue if Congress cannot establish ways to slow Medicare spending, IPAB would be an effective approach for doing so by depoliticizing spending decisions through the use of a board of appointed experts. This work provides an overview of how growth in Medicare spending threatens Medicare's sustainability, the competing stakeholders' reasons for supporting or opposing IPAB, the policy alternatives at hand, and a recommendation for modifying the execution of IPAB.