IPAB Problems

Who will be willing to serve on IPAB? In my post friday noting that Rep. Paul Ryan supported IPAB-like boards in the Patients’ Choice Act that he sponsored in 2009 before he became a critic of IPAB as passed in the ACA, a commenter (Richard Hirth) to my post noted worries about who would be willing to serve on this board due to requirements that members must leave their job to avoid conflicts of interest. He said:

IPAB needs to be strengthened both in an obvious way (not having their scope of action be so limited as to be meaningless) and a less obvious way (eliminating the requirement that it be a full time job for a six year term). MedPAC has been able to engage top notch folks like Joe Newhouse BECAUSE they didn’t have to effectively end their careers to serve. I find it unlikely that anyone willing to serve given the limited authority and the long, full-time time term prohibiting any outside employment is going to be someone I’d want to have in that position. [emphasis mine]

Politico writes about this worry today:

But even aside from the political controversy, the design of the board could make it an unattractive job for some of the nation’s best-known health policy leaders. To avoid any conflicts of interest, they’d have to leave whatever job they’re doing now for up to six years — the length of a full term.

Jon Gruber and Gail Wilensky both note reservations about this aspect of the IPAB.

The problem is that this is a full-time job with a long appointment that would effectively require giving up an academic career, so I can’t see many folks I know being interested in this, says Gruber….and it will be hard to get appropriate people for the board, given that they’d have to make it a full-time job and the Senate would go through every last detail of their records, agrees Wilensky.

The goal of IPAB is to get experts in relevant fields to make decisions, but the requirement for members to leave their job that is the source of their expertise in the first place seems like a bad idea to me. I understand the need to worry about conflicts of interest, but the other danger of ruling out some of the best people to serve on such a board over-rides those concerns for me. This is just one example of where I think IPAB needs to be revised.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

One Response to IPAB Problems

  1. Kevin Outterson says:

    Tim Jost raised similar questions in the NEJM back in May 2010: “Many questions remain about how, and indeed whether, the IPAB will work. Staffing the board with 15 leading experts who are willing to give up research, practice, and teaching for 6 years for a relatively modest salary will be a challenge. The relationships between the IPAB and other boards and commissions, such as the Medicare Payment Advisory Commission and the Center for Medicare and Medicaid Innovation created by the ACA, will need to be negotiated. Although multiple entities pursuing the same tasks could stumble over each other, there are also real opportunities for synergy. In particular, shared staffing between the IPAB and the innovation center could strengthen both.”

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