Reform Update: PCORI approves over $1B for comparative effectiveness research in 2014-15

The board of governors of the Patient-Centered Outcomes Research Institute voted Monday to approve a two-year commitment of more than $1 billion in funding for comparative effectiveness research.

That figure, which covers 2014 and 2015, marks a significant per-year jump from the $400 million PCORI officials have estimated they will award by the end of 2013, an amount that includes $114 million in research grants announced in September.

The commitment includes a projected $528 million for research awards in 2014. Additionally, the board approved an operating budget of $182 million for the upcoming year.

PCORI-funded research addresses a wide range of areas, including health disparities, shared decision-making, chronic disease management and research methods.

At a meeting in Atlanta, the board also discussed the group's long-term funding options. Established by the healthcare reform law, PCORI receives its money—an estimated $3.5 billion through 2019—through a trust fund that draws on the U.S. Treasury Department's general fund and a fee on insurance plans.

Dr. Joe Selby, PCORI's executive director, proposed allocating those funds at higher levels over the next three years and then gradually tapering off in later years, an approach he said would fund more comparative effectiveness research in the near future and produce faster results. After outlining various options, the board tabled the discussion on long-term funding for future meetings, a spokeswoman said.

The board also approved and released a revised version of its 139-page methodology report, which includes 47 standards for conducting comparative effectiveness research. For instance, the report recommends that researchers use validated methods to account for missing data and use patient-reported outcomes, where appropriate.

“Departures from basic good research practices are partially responsible for mismatches between the quality and relevance of the information research provides and the information patients need to make informed clinical decisions,” PCORI said in the report.

The board of governors also approved advisory panels on rare diseases and clinical trials.

The healthcare reform law aggressively targets rising rates of healthcare-associated infections with beefed-up funding for prevention infrastructure and infection surveillance.

Now new findings suggest that healthcare-associated infections after cardiac surgery are a major contributor to rising healthcare costs.

Researchers calculated that treating a major infection following cardiac surgery procedures, such as coronary artery bypass graft, costs about $40,000, fueled mainly by intensive-care stays.

Additionally, “patients with major HAIs were nearly twice as likely to be readmitted” as patients who underwent cardiac surgery but did not contract infections, they reported at the America Heart Association's Scientific Sessions meeting.

The researchers examined data from more than 4,300 patients treated at nine academic medical centers, 2.7% of whom experienced major infections, such as sepsis or Clostridium difficile, during hospitalization.

“Our analysis found readmissions due to HAIs after cardiac surgery cost on average nearly three times as much as non-HAI related readmissions,” said Giampaolo Greco, assistant professor of health evidence and policy at the Icahn School of Medicine at Mount Sinai, New York.

The data, said Greco, show the need to prevent postoperative infections not only to improve patient outcomes but also to reduce costs.

Blue Cross and Blue Shield of Texas and 51-hospital Tenet Healthcare Corp., Dallas, have announced plans to form a statewide accountable care organization, launching Jan. 1, 2015. The ACO will operate through Tenet's integrated-care networks and will be available to any Tenet patients enrolled in a Texas Blues preferred provider organization, according to a joint news release.

“Tenet's Texas integrated-care networks currently include South Texas Care Connect in San Antonio, Physician Performance Network of Houston and the Sierra Providence Physician Performance Network in El Paso,” the groups said.

Follow Maureen McKinney on Twitter: @MHMMcKinney