A May 2010 American Medical Association survey of 9,000 doctors found that 17 percent of physicians are already restricting the number of Medicare patients served by their practices. When asked how they’d cope with a 21 percent cut, more than half said they’d limit the number of Medicare patients they’d treat.
Also on the Medicare front, many physician groups plan to continue their opposition to the Independent Payment Advisory Board (IPAB) created by the health reform law, called the Patient Protection and Affordable Care Act (ACA). The 15-member board is appointed by the President and confirmed by the Senate. If expenditures are expected to exceed the target growth rates set by the law for Medicare, the IPAB must recommend proposals to reduce spending. The IPAB cannot submit proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase beneficiary premiums and cost-sharing requirements, or reduce low-income Part D subsidies. Through 2019, the board is prohibited from recommending payment cuts to providers, primarily hospitals and hospices, that are already slated for reductions. The IPAB may propose physician payment cuts, however, and this worries doctors.
The Department of Health and Human Services must implement IPAB proposals unless Congress adopts an alternative with equal savings. Although lawmakers can override the board, “it becomes a very political situation,” Dr. Imber said. “To have this independent board is very scary. It needs to go.”