Connections : Join the Conversation - The blog of Biomet CEO Jeffrey R. Binder
22
Sep
How doctors view comparative effectiveness research
The Medicare Payment Advisory Commission (MedPAC) recently presented its analysis of comparative effectiveness research (CER), according to a September 18, 2009 article in CQ HealthBeat by John Reichard, CQ HealthBeat Editor.
Included in the analysis are the results of focus group interviews with doctors on CER’s usefulness to their practices.
MedPAC concluded that while the government’s CER initiatives are “not well understood by practicing physicians,” physicians are generally receptive to new data, but some are wary that CER will lead to “mandatory guidelines from the government and private insurers about how they should practice medicine.”
Other MedPAC findings reported in the article are as follows:
- Doctors expressed a desire to receive data comparing drugs, devices, and medical procedures, stating that current “best practices” are not always evidence-based.
- Doctors expressed concern about the impact of CER on innovation
- The prevailing view of doctors was that all research has biases. A MedPAC staffer stated that “even the government could be biased toward less expensive treatments.”
- Doctors want more data on the comparative effectiveness of new, expensive technologies before they become widely used.
- CER should be transparent, with study details and conflicts of researchers reported.
As currently structured, the council charged with implementing CER and the top priorities proposed for study fail to meet doctors’ expectations in several important ways. Only government officials are appointed to the Federal Coordinating Council on Comparative Effectiveness Research (hereafter referred to as the CER council). No public comment period or review is provided for. And nothing prohibits Medicare from using CER in making coverage decisions.
Perhaps most importantly, we share doctors’ concerns that practice guidelines might become mandatory. Suppose a particular therapy that works extremely well in Dr. Smith’s hands for his carefully selected patients is deemed by the CER council to be ineffective because study results are inconclusive. Will it matter that the patient population in the study might not have been as carefully limited? Or that, as is often the case, there are simply situations where a specific treatment works well for some surgeons but not others?
Additionally, the top 100 priorities for study suggested by the Institute of Medicine in June are largely comprised of topics other than comparative effectiveness of treatments. According to CQ: “Half of the topics evaluate some aspect of the healthcare delivery system, a third address racial and ethnic disparities and a fifth address patients’ functional limitations and disabilities, the analysis found.”
While we support well-designed CER that is transparent, we believe that the public should have the opportunity to review the CER council’s work and to have an opportunity to comment on its priorities and research prior to release.
The composition of the CER council is also troubling. Stakeholders, including physicians, patients, and manufacturers of medical devices and drugs should be allowed to participate in its governance, but are currently excluded.
We are less concerned with the impact of CER on innovation, because in our field, we believe that innovations have led to improved cost-effectiveness. We welcome the opportunity CER provides to make the case for our latest technologies.
The Senate Finance Committee’s recently released draft of healthcare reform legislation takes important steps to address the shortcomings of the current CER law. The draft reflects a CER bill introduced by Senators Baucus and Conrad earlier in the year (S. 1213). Key provisions include:
- stakeholder representation on its board, including physicians, manufacturers, and patients,
- prohibition from using CER alone to deny coverage of treatment, and
- inclusion of public comment periods
Regardless of the fate of healthcare reform, the Baucus-Conrad provisions would go a long way to making CER align more closely with the expectations of doctors.
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