When you add $1.1 billion to what was once a $15 million a year enterprise, you get a lot of suggestions on what to do with that money. To ensure that not all those suggestions were coming from Washington insiders, 11 members of the new 15-person Federal Coordinating Council for Comparative Effectiveness Research traveled on Wednesday to Chicago for a listening session.
Comparative-effectiveness group talks big money
Attorney Neera Tanden, who currently serves as HHS counselor for health reform, led the session and said it was an attempt to get outside the beltway to hear other opinions and suggestions on how to spend the $1.1 billion allocated for comparative-effectiveness research in the American Recovery and Reinvestment Act of 2009. To that end, the session was successful as the panel received an earful from the more than 20 speakers.
There were calls for transparency, to fill specific research gaps and to look at broad, silo-crossing strategies. Arturo Bendixen, vice president for programs and partnerships for the AIDS Foundation of Chicago, spoke of the improvements that could be made if the systems in place to help the homeless and to provide healthcare for the poor worked together.
Scott Wallace, former president and CEO of the National Alliance for Health Information Technology, suggested that comprehensive health registry population databases be included in any comparative-effectiveness program.
He also warned against further segmentation of care and stifling innovation under blankets of bureaucracy as has happened in the U.K. Now a fellow with the Batten Institute at the University of Virginias Darden School of Business, Wallace said that he was speaking as an individual and was not representing any organization or institution.
Wallace said that the focus of comparative-effectiveness research should be on outcomes and not on micromanaging processes. He cited how improvements in treating pediatric cancer and cystic fibrosis were made by using team approaches and testing full-treatment protocols and not specific procedures or medications.
Others, however, called for filling gaps in specific areas of research. Naomi Aronson, executive director of the Blue Cross and Blue Shield Associations Technology Evaluation Center, said that these gaps include the management of patients with chronic stable angina or the treatment of patients with localized prostate cancer. While Michael Saliba, chairman of the Saliba Burns Institute, La Jolla, Calif., specifically called for more research on the use of heparin to treat burns.
Suggestions were also made for building a comparative-effectiveness research infrastructure. Elsa Schafer, CEO of Health Metrics Systems, a company formed at the Palo Alto (Calif.) Medical Foundation, suggested the development of a national interoperable data-exchange platform for researchers to access and provide information to be used for benchmarking and the sharing of best practices.
(Later Schafer also suggested funding experiments for EHR-lites for institutions who could not afford full electronic health-record systems. She recommended diagnostic aids and safety net facilities get top priority in this research.)
Thomas Wilson, an epidemiologist and chairman of the Annapolis, Md.-based Population Health Impact Institute, said that the comparative-effectiveness research infrastructure would be stronger if those who performed peer review of the research thats conducted were adequately paid for their work.
We pay referees at basketball games; we pay judges in court, Wilson said. Noting the need to verify research findings, Wilson urged the panel to take the advice of the 17th-century founders of the Royal Society of London: Nullius in verba, which is roughly translated as: "Dont take anyones word for it."
Similarly, Steven Mersch, president of Point Source, a Germantown, Ohio, manufacturer of electronic and optical instruments, suggested that research include testing compliance-verification devices that would measure how well patients followed doctors orders.
Maryellen Giger, a University of Chicago professor of radiology and the president of the American Association of Physicists in Medicine, suggested a technology assessment institute be established that would use physical measures and other means to determine if new devices were ready for testing and if clinical trials would be worthwhile.
Panel member Carolyn Clancy, the director of the Agency for Healthcare Research and Quality who was recently voted the nations most powerful physician-executive by Modern Healthcare and Modern Physician readers, suggested that one aspect of this infrastructure could be a dissemination process that would work so well that good, reliable information is almost impossible to avoid. (Of the $1.1 billion appropriation for comparative effectiveness research in the stimulus act, AHRQ was allocated $300 million, while $400 million went to the National Institutes of Health and $400 million was left to be allocated at the discretion of HHS Secretary Kathleen Sebelius.)
Perhaps the most passionate speaker was the last. Noting that more care can sometimes be worse care, James Webster, a professor of medicine at Northwestern Universitys Feinberg School of Medicine and the immediate past president of the Chicago Board of Health, spoke about the importance of clinical effectiveness research. As the saying goes, In God we trust; all others should bring data, he said.
Translating scientific research into the implementation of best medical practices was vital to the nations economy, Webster said. In my opinion, this is not an effort to do rationing, when healthcare is currently rationed on the basis of insurance coverage and ability to pay, he said. We cannot ignore the fact that we are in danger of bankrupting both the healthcare system and the country.
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