Rationing healthcare was the buzz of talk radio yesterday as Rush Limbaugh warned that the stimulus bill’s $20 billion for health IT would undermine patient privacy while Betsy McCaughey made the rounds with Laura Ingraham and Glenn Beck to warn that the $1 billion in the stimulus bill for comparative effectiveness research, coupled with the new Office of the National Coordinator of Health Information Technology, will lead to the Daschle cure for reducing healthcare costs as outlined in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis”.
Comparative effectiveness is a relatively “wonky term” to generate the type of resonance it did in the first round of media coverage, as well as the subsequent vetting of McCaughey’s statements by MSNBC and CNN. The final stimulus bill represents a win for the House Democrats who fought back the Senate’s desire to limit the research to “clinical” effectiveness research rather than the broader “comparative” effectiveness research of the cost effectiveness of a technology or service as well as evaluating differences in the clinical benefit or outcomes of two or more healthcare services.
The Agency for Healthcare Research and Quality (AHRQ) is set to receive $300 million for comparative effectiveness research; a 20 fold budget increase for these activities which were initiated as a result of the Medicare Modernization Act (MMA) of 2003, passed by a Republican led Congress. The recent AHRQ tech assessment on CT colonography compared the cost effectiveness ratios for several types of screening tests for colorectal cancer (CRC). The report figured prominently in the draft coverage decision on CT colonography, issued earlier this week by the Center for Medicare and Medicaid Services (CMS).
CMS staff appear to prefer the use of comparative effectiveness research rather than limiting itself to clinical effectiveness research. The proposed coverage decision notes that if the Agency was to determine (in the next 90 days) that CT colonography is clinically effective, it would also need to determine if CT colonography is cost effective.
The stimulus bill’s conference report notes that comparative effectiveness research is not intended to be used to “mandate coverage, reimbursement, or other policies for any public or private payer”. While the research may not “mandate” coverage policy, it is possible that it will continue “inform” coverage policy.
The health IT and comparative effectiveness provisions represent a clear win for President Obama’s commitment to make a "down payment" on healthcare reform. No wonder wonky terms are drawing such fire.