My friend Peter Bach has been one of the busiest and arguably most thoughtful health care policy experts in recent months. (Then again, as Red Sox fan, Peter has lots of time on his hands this fall!) As he knows, I don't always agree with his conclusions but they are always built on scientific research and always thoughtful. He is also a physician who puts his patients first. His editorial on the Women's Health Initiative study demonstrating a slight increase in risk of death from cancer in women ages 50-70 who took PremPro is an example of this approach. He calls for research to investigate the relationship between the likely mechanism and pathways that may be implicated in this reported risk and outcomes in a prospective study. No one can argue with that. Or should they.
Peter has written a lot on comparative effectiveness research and has some suggestions about how to encourage it and conduct it in ways that promote better care and less cost. As the Economix blog put it: "using the research not to decide whether to cover a procedure but instead to decide how much to pay for it. If there isn’t research showing that a more expensive treatment is more effective than a cheaper treatment, then the reimbursement rate for the cheaper treatment applies to both." Of course if a more expensive treatment is more effective than it should be paid for.
I don't trust the motives of many who make up the CER community and believe that CER research contributes nothing to the goal of improving clinical decisionmaking. Uwe Reinhardt's fippant assertion that differences in clinical pratice can't be controlled for is completely wrong and self serving since Reinhardt endorses using average outcomes of average populations with minimal risk adjustment to decide who gets what. For Reinhardt's smug analysis: economix.blogs.nytimes.com/2010/10/15/basing-pay-for-performance-on-outcomes/
I believe Peter is the exception. The links to his articles and those written about his work are below. He offers a sensible starting point for developing an alternative to the CER slush fund.
jama.ama-assn.org/cgi/content/short/304/15/1719
www.theledger.com/article/20101020/ZNYT01/10203007
economix.blogs.nytimes.com/tag/us-health-care-costs/
content.healthaffairs.org/cgi/content/abstract/29/10/1796
Peter has written a lot on comparative effectiveness research and has some suggestions about how to encourage it and conduct it in ways that promote better care and less cost. As the Economix blog put it: "using the research not to decide whether to cover a procedure but instead to decide how much to pay for it. If there isn’t research showing that a more expensive treatment is more effective than a cheaper treatment, then the reimbursement rate for the cheaper treatment applies to both." Of course if a more expensive treatment is more effective than it should be paid for.
I don't trust the motives of many who make up the CER community and believe that CER research contributes nothing to the goal of improving clinical decisionmaking. Uwe Reinhardt's fippant assertion that differences in clinical pratice can't be controlled for is completely wrong and self serving since Reinhardt endorses using average outcomes of average populations with minimal risk adjustment to decide who gets what. For Reinhardt's smug analysis: economix.blogs.nytimes.com/2010/10/15/basing-pay-for-performance-on-outcomes/
I believe Peter is the exception. The links to his articles and those written about his work are below. He offers a sensible starting point for developing an alternative to the CER slush fund.
jama.ama-assn.org/cgi/content/short/304/15/1719
www.theledger.com/article/20101020/ZNYT01/10203007
economix.blogs.nytimes.com/tag/us-health-care-costs/
content.healthaffairs.org/cgi/content/abstract/29/10/1796
