November 23, 2009
affordable care act sympsoium obamacare narrow networks reference pricing aca contraceptive exchange health reform health insurance exchanges marketplace fqhc safety net decision making patient engagement electronic health records cms electronic medical records health care cost medicaid michigan small business mental health oregon depression readmissions aco health care costs costs medicare health policy exchanges politics wellness programs rules election courts coverage dual-eligible funding cheboygan memorial access communication scotus employers poverty variation cost use quality research policy health insurance acos hmos essential benefits reform sgr congress drugs class long term care va e-prescribing emrs patient safety states for-profit nonprofit block grant tanf welfare reform hospice end of life non-profit evidence-based care waste washtenaw county uninsured population health managed care cancer end-of-life care individual mandate ryan proposal obesity pharmaceutical industry r & d comparative effectiveness research evidence based care quality improvement collaborative quality initiatives cqi pharmaceuticals regulations prematurity heath reform antibiotics overuse geographic variation medical appropriateness health websites imrt radiation therapy medical errors constitutionality translate health care economics rationing insurance regulation incentives cardiology pcmh health disparities british health care system guidelines radiology pain early childhood physician employment dartmouth atlas cover michigan health care coverage insurance preventive care public health
Center for Healthcare Research & Transformation
Health reform is exciting and both the House and Senate bills have elements that could greatly improve the way care is delivered for millions of people. But, with all those great things, you have to know that there are lots of things in those more than 1,900 pages of the House bill and more than 2,000 in the Senate bill that will be an unhappy surprise for those of us who would like to see some fidelity to the idea that we should be advancing the cause of delivering health care based on research and evidence. Fortunately, there are folks who are delving into the bills to raise the visibility of issues of the greatest concern. In its Nov. 18 issue, the New England Journal of Medicine has done a great service in profiling just such an important issue (Industry Influence on Comparative-Effectiveness Research Funded through Health Care Reform).
The article’s authors, Selker and Wood, note that in the Senate Finance Committee health reform bill, there are some major problems with the proposed entity that would perform comparative effectiveness research. First, lobbyists for the medical device manufacturers advocated for and were successful in getting three seats out of the 15 on the governing body. And, second there is a provision of the bill (pages 1138-9) that says that the entity may “withdraw federal funding for five years from any investigator who publishes a report on research funded by the proposed institute that is not ‘within the bounds of and entirely consistent with the evidence.’ Determinations regarding such consistency would be made by the newly created research entity, which would have industry involvement both in its governance and in study design.”
Whoa! The idea behind comparative effectiveness research was to have an independent body add to the evidence and help inform practitioners and the public about what works in health care. Advocates for this kind of research thought of it as a place to get “The Truth” — to provide fair and objective research. It was, of course, never intended to be a shill for the industry. We already have one federal agency (the FDA) whose review of the effectiveness of new devices is limited. This new group was supposed to make progress in assessing the value of both devices and procedures. With the American approach to interest based politics, it is not surprising that the industry would attempt to capture this newly developing entity. Indeed, I suppose given how much industry is interested in this new approach comparative effectiveness research, it says something about its potential for impact. If we really want to make progress on delivering medical care based on the evidence, however, this is one devil that needs to get removed from the detail.