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Rationing — how will it be spun?

Jan 23, 2009• 11

By Sarah Arnquist

The House of Representatives’ $825-billion stimulus package proposed last week included $1.1 billion to fund comparative effectiveness research — research that evaluates two or more medical technologies or treatments to see which is most effective.

This is welcome news to those who say the need for such efforts to ensure the U.S. gets more value from its abundant health care spending is long overdue.

But not everyone thinks comparative effectiveness research is a good idea. Some say it is a front for rationing health services — for allowing the government to make health care decisions instead of doctors.

Inciting fears of rationing will be an easy card to play in the forthcoming health reform debate. If the national goals are to provide universal coverage and control costs, it seems setting some limits on health care would be necessary.

The use of comparative-effectiveness analysis and separately cost-effectiveness analysis fall squarely within this anticipated debate.

Fans of comparative effectiveness research include key players in the Obama Administration: Tom Daschle, Secretary of Health and Human Services; Peter Orszag, Office of Management and Budget director; and Carolyn Clancy, acting director of the Agency for Healthcare Research and Quality (AHRQ).

Many developed countries, including Germany, England, Canada and Australia, already invest in this research and use it to decide what health services to pay for. Many health policy experts, health economists and health plan leaders — both public and private — say the U.S. is behind the times.

Nearly everyone agrees that having more evidence to support clinical decisions is a good thing, but there’s strong disagreement on whether it should be mandatory to guide coverage decisions and whether the analysis should factor in the relative costs of treatments.

Scott Gottlieb, a fellow at the conservative American Enterprise Institute and former FDA official, warned Americans this week in the Wall Street Journal about this “mirage” Democrats are calling comparative effectiveness.

“In Britain, a government agency evaluates new medical products for their “cost effectiveness” before citizens can get access to them. The agency has concluded that $45,000 is the most worth paying for products that extend a person’s life by one “quality-adjusted” year. … Here in the U.S., President-elect Barack Obama and House Democrats embrace the creation of a similar ‘comparative effectiveness’ entity … They claim that they don’t want this to morph into a British-style agency that restricts access to medical products based on narrow cost criteria, but provisions tucked into the fiscal stimulus bill betray their real intentions.”

Gottlieb makes comparative clinical effectiveness analysis and cost-effectiveness analysis seem as though they are the same. They aren’t. It’s true that England uses both in its determination, but supporters of the creating a centralized center to do comparative effectiveness research in the U.S. split on whether or not costs should be included.

Comparative effectiveness research and how it could be used to shape health policy is complex with no singular definition, method or form. Proponents may overstate its ability to save money (it actually doesn’t in most countries where it’s used). Opponents may write it off as an underhanded attempt at rationing. THCB will tease apart those arguments over the coming months. Stay tuned.

When You’re a Wonk, You’re a Wonk All the Way

Jan 23, 2009• 1

Folks at the Health Affairs blog are proudly highlighting a Business Week snippet about incoming health
reform czar and HHS Secretary Tom Daschle. The magazine quotes a friend talking about Daschle’s intensity this way: “He really does unwind by reading [policy journal] Health Affairs.”

As long-time Health Affairs readers, we applaud this seriousness of purpose. However, we cannot help but be reminded of the story of the man who went to see a psychiatrist and complained that all he dreamed about was baseball, baseball, baseball. “Don’t you ever dream about travel, or adventures or women?” asked the shrink. “What,” replied the man, “and miss my turn at bat?!”

Healthcare Reform Should Include Connected Health and Participatory Medicine

Jan 22, 2009• 1

In response to President Obama's call for recommendations on health care reform, the Center for Connected Health, a division of Partners HealthCare, convened an online Community Health Discussion in December, to explore the opportunities and advantages connected health, population management and participatory medicine can offer to health care reform. A report of the discussion findings was submitted to President Obama's Presidential Transition Health Policy Team, led by Secretary of Health and Human Services Nominee Tom Daschle. Over 30 participants, including academic and business leaders, technologists, physicians, health insurers, patients and payers, took part in the discussion. The Center's final report submitted to the Obama team addressed how connected health and its core tools – physiologic monitoring presented to the patient in a meaningful way, and data-driven coaching to help individuals make positive lifestyle and health behavior changes – could play a critical role in transforming health care delivery, improving quality and expanding access to care throughout the U.S.

Doubts about Gupta for Surgeon General

Jan 22, 2009• 3

By Maggie Mahar

Editor's note: Maggie wrote this originally as a comment to Brian Klepper's post, but we thought it worthy of its own headline.

I vote for Dr. Lundberg–who I know, admire and trust.

I am troubled by Dr. Gupta's nomination because I have heard him
promote products or treatments on television while ignoring the best
medical evidence. In other words, he misinforms the public–without hinting that he is contradicting current best practice guidelines.

There are disturbing ties to Pharma which suggest conflict of interest.

Professor Gary Schwitzer of the University of Minnesots's
Journalism school documents many of these incidents on his excellent
blog "Health News Review."

Cats & dogs: Can we find unity on health care IT change?

Jan 22, 2009• 7

By Matthew Holt

Those of you paying attention for the past few days might have noticed on the one hand a sense of optimism and unity as Barrack H. Obama, somewhat somberly, began his presidency.

Meanwhile, over the past few weeks the fur has been flying among the electrons on THCB while some very knowledgeable and opinionated health care wonks and geeks have been battling it out about what exactly we should be doing in terms of federal health care IT spending.

Strategic Implementation of the NHIN

Jan 22, 2009• 3

By Kepa Zubeldia

In the last few weeks, it has become evident that a National Health Information Network (NHIN) has the
political support necessary to become a reality and to help the health care system progress to a twenty-first century interconnected environment. The question is no longer what, if, or when — but how to deploy such a network.

The American National Standards Institute’s Healthcare Information Technology Standards Panel (HITSP) has been identifying scenarios that are most urgent to automate and has identified the standards to be used for the electronic exchange of health information. The Certification Commission for Healthcare Information Technology (CCHIT) has been certifying systems that comply with the standards, and is now in the process of preparing interoperability certification procedures.

The Department of Health and Human Services (HHS) Office of the National Coordinator (ONC) for Health Information Technology has been promoting an interoperable national health information network for the last few years and has provided the necessary funding for the pilot projects that are demonstrating the technical feasibility of an interoperable NHIN. One of the necessary steps in deploying the NHIN is to have a financial funding mechanism that will provide for the long term operation of such network.

Perhaps it is time to look at how the NHIN can be built by the health care industry without the need for long term government and grant funding.

Online communities helped psoriasis sufferers

Jan 22, 2009• 11

By Matthew Holt

In one of the first articles of this type I've seen published in a mainstream medical journal, in this case the Archives of Dermatology, there's some evidence that being in an online community helps patients. This study is from our friends at the Partners Center for Connected Health which is run by Joe Kvedar, himself a dermatologist. (No I haven't spoken to Joe about it and I don't know if his specialty is why they picked on psoriasis—other than it’s a very nasty condition).

Anyway, the key take-away from an attitudinal study of over 200 patients in five online communities is that:

Almost half (49.5 percent) of participants perceived improvements in their quality of life and 41 percent perceived improvements in psoriasis severity since joining an online support community.

And all this from a treatment with no costs and no side effects. Even Syd Wolfe — new ~~head of~~ committee member of drug safety at the FDA much to Forbes dismay— (Editor's note: That'll teach us to read Forbes! Goldstein got it right. and yes it is that Sydney Wolfe) would approve!

I expect that as Health 2.0 tactics go mainstream we’ll hear a lot more about these types of cases.

Johns Hopkins professor presents on improving patient-physician communications

Jan 21, 2009• 1

WHO: The Herschel S. Horowitz Center for Health Literacy at the University of Maryland School of Public Health hosts guest speaker Debra Roter, DrPH, as part of their ongoing Speaker Series.

WHAT: Dr. Roter, a Professor at Johns Hopkins Bloomberg School of Public Health, will present a lecture entitled "Improving the Quality of Patient-Physician Communications: A Prescription for Health Literacy." She will discuss her research into how doctors and patients speak with each other and present strategies on how to improve both their interactions and the health outcome of patients.

WHEN: Friday, January 30, 2009 from 2:00

The greatest health care IT generation

Jan 21, 2009• 2

By John Halamka

In Washington, Healthcare Information Technology policy planning is
accelerating at a pace that is faster than at any time in history (at
least my 30 years in healthcare IT).

Over the past few days, the House Ways and Means Committee completed the Health Information Technology for Economic and Clinical Health Act (HITECH), as part of the American Economic Recovery and Reinvestment Plan.

At the same time, the House Appropriations Committee has completed a bill
that is not meant to stand alone. It outlines $2 billion in funding for
the programs authorized by section 4301 of the Ways and Means Committee
bill.

Op-Ed: Healthcare Reform Lessons From Mayo Clinic

Jan 21, 2009• 45

By LEONARD L. BERRY and KENT D. SELTMAN

Three goals underscore our nation’s ongoing healthcare reform debate:1) insurance for the uninsured, 2) improved quality, and 3) reduced cost. Mayo Clinic serves as a model for higher quality healthcare at a lower cost.President Obama, after referencing Mayo Clinic and Cleveland Clinic, advised, “We should learn from their successes and promote the best practices, not the most expensive ones.”

Atul Gawande writes in The New Yorker, “Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country-$6,688 per enrollee in 2006.”Two pivotal lessons from our recent in-depth study of Mayo Clinic demonstrate cost efficiency and clinical effectiveness.