IPAB – the independent payment advisory board is a key feature of the ACA. This board will do what many countries already do – have an independent expert panel to assess the effectiveness of procedures, imaging studies, pharmaceuticals, etc.

Why do we need this board? We need careful assessments of new trends in medicine. Let me suggest two situations.

We have read much about increasing colonoscopy costs. We have a controversy about anesthesia – conscious sedation versus a more standard anesthesia with propofol. The former only requires the gastroenterologist; the latter adds an anesthesiologist, and therefore another huge bill. What should Medicare pay for colonoscopy, and should they pay for the anesthesia?

A new drug is developed for lung cancer. It costs 10 times standard therapy. Oncologists and the pharmaceutical company both make more money from using this drug. How do we determine its worth? This question is hypothetical but very similar to situations that we see for many pharmaceuticals.

Here is a quick list of issues I would want advice on:

Routine screening for aortic aneurysm at age ??
Colonoscopy for colorectal cancer screening after 2 normal colonoscopies
Interval for repeat echocardiograms
Criteria for starting home oxygen in COPD or restrictive lung disease (Medicare uses < 89% oxygen saturation, VA uses < 92%) First line antibiotics for MRSA Firm criteria for artificial joints What is your list? Note that the IPAB can recommend payment decisions, but that Congress can overrule. This board will create some controversies, but we must contain costs. We can only do that through choosing wisely about health care expenditures. We need a group of independent experts to provide such decisions and the rationale for those decisions. IPAB is a good idea.