Berwick: We might not need IPAB after all

Speaking to Kaiser Health News, CMS Administrator Don Berwick said that the controversial Independent Payment Advisory Board (IPAB) may not be necessary if last year's federal health reform law is given time to work.

Berwick, who was in Philadelphia for a conference of health care journalists, told Kaiser Health News that the IPAB—which is designed to push for Medicare cuts if the program's spending grows faster than targets—is a useful "default system" to help control health costs. Under the federal health reform law, IPAB would include 15 health expert members and make congressional recommendations to reduce Medicare expenditure growth per beneficiary to the growth of the gross domestic product (GDP) per capita plus 1%.

As part of a broader speech on ways to curb federal spending, President Obama last week proposed lowering IPAB's trigger from GDP plus 1% to GDP plus 0.5%. The announcement spurred further resistance among some members of Congress—including Democrats—who already have been critical of IPAB's potential reach, suggesting that the unelected commission would gain too much authority over Medicare decisions.

According to Berwick, the nation will not "have to get to that point" if provisions in the federal law, which he says are intended to improve health care quality and delivery, can take effect. For example, Berwick cited new structures that encourage provider cooperation, such as accountable care organizations, and the new Center for Medicare and Medicaid Innovation as two initiatives that could lower spending and raise outcomes without IPAB (Jaffe, Kaiser Health News, 4/15).