Los Angeles Times Examines Efforts by Policymakers, Researchers To Adopt Comparative Effectiveness Model To Control Health Care Costs

The Los Angeles Times on Monday examined how lawmakers and medical researchers have begun examining "the controversial idea" of encouraging "doctors and patients to use particular drugs and treatments in order to save money" through comparative effectiveness research. According to the Times, "it seems simple enough" that "[b]illions of dollars could be saved" by encouraging treatments "that research showed were best and most cost-effective." However, the Times notes that there is a "cherished American belief that medical decisions are nobody's business but the patient's and the doctor's."

According to the Times, comparative effectiveness research would likely first identify "best practices," though later Medicare and private insurers might come under pressure to penalize providers who do not adopt the guidance. Research initially might focus on little-used treatments, but "common treatments" also could face scrutiny, according to the Times. Some experts say that in the future, patients could pay smaller fees for "high value" procedures and higher copayments for "low value" treatments.

Proposals
Senate Finance Committee Chair Max Baucus (D-Mont.) and Senate Budget Committee Chair Kent Conrad (D-N.D.) plan to propose legislation to establish a federal institute to address and increase the efficiency of Medicare and Medicaid through comparative effectiveness research.

A plan proposed by presumptive Democratic presidential nominee Sen. Barack Obama (Ill.) would create a federal department to examine cost-effective health care options. Meanwhile, an adviser to presumptive Republican presidential nominee Sen. John McCain (Ariz.) said it is "imperative" for more emphasis to be placed on cost-benefit studies. Both Obama and McCain note that their objective is to facilitate information that would help patients and physicians make better medical decisions and not influence health care coverage, according to the Times.

Gail Wilensky, a former Medicare administrator and health policy expert, has proposed the creation of a government institute with an annual budget of $5 billion that would conduct comparative effectiveness research, a move that she said would be a worthwhile investment compared to the $2 trillion that is spent annually in the U.S. on health care.

Comments
Sean Tunis, a former Medicare chief physician, said, "People have pointed out that a lot of the care in our system is inefficient, wasteful or inappropriate -- maybe 20% or 30%," adding that "any efforts to restrain spending on unnecessary care are going to involve difficult decisions depriving people of things they need, or think they might need." Tunis added, "We haven't been very honest about it, and we haven't figured out a good way to do it."

Wilensky said, "Learning how to spend smarter is one of the three or four critical things that needs to happen in our health care system," adding, "Not only is it something the Democrats have been interested in, but a number of Republicans think this is the kind of information that is consistent with market strategies (to reform health care) that help doctors and patients make better decisions" (Alonso-Zaldivar, Los Angeles Times, 6/9).