Comparative Effectiveness in hb 3200

This is post #6 related to the proposed h b 3200. Hopefully, you have read the others.

On page 502 of the bill, the Sec. HHS is given the power to establish within the Agency for Healthcare Research and Quality (AHRQ) a Center for Comparative Effectiveness Research to conduct, support, and synthesize research…with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.

That sounds pretty nice doesn’t it? How in the world could that be bad? It seemed so good, I just had to check out the term “comparative effectiveness” because I knew the geniuses in Congress wouldn’t have create that on their on.

In “Comparative Effectiveness: Better Value for the Money?” (August, 2008) issued by the Alliance for Health Reform, they state: “…CE aims to assess how various procedures or interventions for a given ailment compare with each other.”

Can the government which controls the research establish health cost ceilings and floors for payments to providers (and therefore, the patient)?

I found a paper (“Comparative Effectiveness of Health Interventions: Strategies to Change Policy and Practice”) from 2007 issued by ECRI Institute. They are an Evidence-based Practice Center as designated by the U. S. Agency for Healthcare Research and Quality (AHRQ) and a Collaborating Center of the World Health Organization. I added the color. In the executive summary on page 1, I found this:

“Proponents of comparative effectiveness research say objections and counter-arguments should be anticipated. Comparative effectiveness guidance will be resisted if it is seen as primarily a tool to control healthcare costs. On the other hand, it is more likely to be embraced if the information helps patients and providers raise the quality of healthcare and reap greater value.” Again, my color added.

OK so don’t tell us that the goal is to reduce cost; tell us that the goal is to improve the quality of health care.

I also found a CBO report to Congress by Peter Orszag in December, 2007. This paper presents the pros and cons of CE research, who should perform the research, and whether or not cost-effectiveness should be considered in the research. This is very important because such an inclusion requires the use of another set of values called “quality-adjusted life years.” Included in the report is this:

“By convention, cost-effectiveness analyses report results as the cost per QALY gained, so a lower dollar amount indicates a more cost-effective service. If that metric is used to determine whether specific health procedures are covered by an insurance program, choosing a cost-effectiveness threshold can be a controversial endeavor.”

As an example, assume a procedure will cost $57,000 and the patient would “gain” 35 quality years (determined by a gov’t chart). That is a cost of approximately $1,629 per life year. Suppose that same procedure is considered for someone with only 5 quality years gained. That would be $11,400 per life year. Hmmmm, better not do that one.

But my gov’t wouldn’t do that.

Members of Congress like to model things by the way other parts of the world do them. QALY is applied all across Europe. Why not here?

The stimulus bill allowed for 1.1 TRILLION dollars set aside for such research. The current health care bill allows for an addition 90 MILLION in 2010, 100 MILLION in 2011, 110 MILLION in 2012. Then in 2013 and thereafter, there is a formula based upon fees charged to insurance companies and self-insured plan AND a transfer based upon the number of us in the Medicare program. That money is transferred from the Medicare fund!!!

Let me see if I understand this. TRILLIONS of dollars are going to be spent to find ways to save money in health care costs. What amount of annual savings should be expected if we invest TRILLIONS of dollars for research?