Pain Management Center of Paducah, Paducah, Kentucky, USA.
Pain Physician. 2011 Jul-Aug;14(4):E313-42.
The Independent Payment Advisory Board (IPAB) is a vastly powerful component of the president's health care reform law, with authority to issue recommendations to reduce the growth in Medicare spending, providing recommendations to be considered by Congress and implemented by the administration on a fast track basis. Ever since its inception, IPAB has been one of the most controversial issues of the Patient Protection and Affordable Care Act (ACA), even though the powers of IPAB are restricted and multiple sectors of health care have been protected in the law. IPAB works by recommending policies to Congress to help Medicare provide better care at a lower cost, which would include ideas on coordinating care, getting rid of waste in the system, providing incentives for best practices, and prioritizing primary care. Congress then has the power to accept or reject these recommendations. However, Congress faces extreme limitations, either to enact policies that achieve equivalent savings, or let the Secretary of Health and Human Services (HHS) follow IPAB's recommendations. IPAB has strong supporters and opponents, leading to arguments in favor of or against to the extreme of introducing legislation to repeal IPAB. The origins of IPAB are found in the ideology of the National Institute for Health and Clinical Excellence (NICE) and the impetus of exploring health care costs, even though IPAB's authority seems to be limited to Medicare only. The structure and operation of IPAB differs from Medicare and has been called the Medicare Payment Advisory Commission (MedPAC) on steroids. The board membership consists of 15 full-time members appointed by the president and confirmed by the Senate with options for recess appointments. The IPAB statute sets target growth rates for Medicare spending. The applicable percent for maximum savings appears to be 0.5% for year 2015, 1% for 2016, 1.25% for 2017, and 1.5% for 2018 and later. The IPAB Medicare proposal process involves mandatory recommendations and advisory recommendations with multiple reporting requirements. However, although IPAB has been described as having limited authority, some believe that it has unlimited authority due to the lack of judicial review and the requirement of two-thirds of the Congress to override any recommendations by IPAB.
独立支付咨询委员会（IPAB）是总统医疗改革法中一个极具影响力的组成部分，有权就降低医疗保险支出增长提出建议，供国会考虑，并由行政部门在快车道上实施。自成立以来，IPAB 一直是《患者保护与平价医疗法案》（ACA）最具争议的问题之一，尽管 IPAB 的权力受到限制，医疗保健的多个领域在法律中得到了保护。IPAB 通过向国会提出建议来帮助医疗保险以更低的成本提供更好的护理，其中包括协调护理、消除系统中的浪费、为最佳实践提供激励以及优先考虑初级保健的想法。国会然后有权接受或拒绝这些建议。然而，国会面临着极端的限制，要么制定实现同等储蓄的政策，要么让卫生与公众服务部部长（HHS）遵循 IPAB 的建议。IPAB 有强烈的支持者和反对者，导致了支持或反对的极端争论，甚至提出了废除 IPAB 的立法。IPAB 的起源可以追溯到国家卫生与临床卓越研究所（NICE）的意识形态和探索医疗保健成本的动力，尽管 IPAB 的权力似乎仅限于医疗保险。IPAB 的结构和运作与医疗保险不同，被称为“类固醇版”的医疗保险支付咨询委员会（MedPAC）。委员会成员由总统任命的 15 名全职成员组成，并经参议院确认，可选择在休会期间任命。IPAB 法规为医疗保险支出设定了目标增长率。适用的最大储蓄百分比似乎是 2015 年为 0.5%，2016 年为 1%，2017 年为 1.25%，2018 年及以后为 1.5%。IPAB 医疗保险提案流程涉及强制性建议和咨询建议，以及多项报告要求。然而，尽管 IPAB 被描述为权力有限，但有人认为它拥有无限的权力，因为缺乏司法审查以及国会三分之二多数票才能推翻 IPAB 的任何建议。
