I received a nice 20 page glossy report from Blue Cross Blue Shield Association entitled:
"The Pathway to Covering America:Ensuring Quality, Value and Access." Let's set aside the image of a pathway covering something (isn't that a bit convoluted?) and the semi-fictitious factoids about health care (people without coverage get sicker and die sooner than those with coverage, sort of true but not always so for many, many reasons).
The heart of the proposal is the claim that "America needs an independent institute to support research comparing the relative effectiveness of new and existing medical procedures, drugs, devices and biologics" and that "Medicare and other public program should be required to consider the Institute's research in developing pay for performance, coverage, reimbursement and other policies."
So social scientists culling through research -- using meta- analysis mostly -- will create practice guidelines that will dictate to doctors and patients what care they will receive. All paid for by a tax on our premiums.
BCBS says that the Institute should contract with existing entities to facilitate research and collaborate with "institutes that receive comparative research contracts to identify best practices...in order to maximize research dollars."
Guess who has an "existing" entity?
BCBS. In the form of a Technology Evaluation Center. And it is already "one of the 14 Evidence-Based Practice Center for the US Agency for Healthcare Research and Quality. It also provides evaluations to Medicare and Medicaid. BCBS says: " TEC Assessments should not be construed to suggest that the Blue Cross Blue Shield Association, Kaiser Permanente Medical Care Program or the TEC Program recommends, advocates, requires, encourages, or discourages any particular treatment, procedure, or service; any particular course of treatment, procedure, or service; or the payment or non-payment of the technology or technologies evaluated."
Of course not! Who would think such a thing! But imagine if Phrma or BIO instead of BCBS or Kaiser were running a TEC that in turn would be part and parcel of the Comparative Effectiveness Institute right off the bat. The screams about conflict would be heard round the world.
Meanwhile, here's a flavor of how slow-footed and lethal TEC transfer can be.
The munchkins at TEC central went on and on about how there was, for off-label indications of sunitinib or Nexavar (hepatocellular carcinoma), no studies were found that met selection criteria for this assessment (Who died and made them king?) That included use for renal cell carcinoma. So in otherwords the progression free survival of patients on Nexavar reported in the NEJM means nothing, as does the reports of efficacy in several other studies. (See Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007 Jan 11;356(2):125-34.) But of course " assessments should not be construed to suggest that the Blue Cross Blue Shield Association, Kaiser Permanente Medical Care Program or the TEC Program recommends, advocates, requires, encourages, or discourages any particular treatment, procedure, or service; any particular course of treatment, procedure, or service; or the payment or non-payment of the technology or technologies evaluated."
Of course not. We will leave that to the national Comparative Effectiveness Board which will collaborate with TEC to maximize research dollars.
Let's see Healthcare Renewal and the other conflict of interest police defend this one. Letting people die to save dollars...
"The Pathway to Covering America:Ensuring Quality, Value and Access." Let's set aside the image of a pathway covering something (isn't that a bit convoluted?) and the semi-fictitious factoids about health care (people without coverage get sicker and die sooner than those with coverage, sort of true but not always so for many, many reasons).
The heart of the proposal is the claim that "America needs an independent institute to support research comparing the relative effectiveness of new and existing medical procedures, drugs, devices and biologics" and that "Medicare and other public program should be required to consider the Institute's research in developing pay for performance, coverage, reimbursement and other policies."
So social scientists culling through research -- using meta- analysis mostly -- will create practice guidelines that will dictate to doctors and patients what care they will receive. All paid for by a tax on our premiums.
BCBS says that the Institute should contract with existing entities to facilitate research and collaborate with "institutes that receive comparative research contracts to identify best practices...in order to maximize research dollars."
Guess who has an "existing" entity?
BCBS. In the form of a Technology Evaluation Center. And it is already "one of the 14 Evidence-Based Practice Center for the US Agency for Healthcare Research and Quality. It also provides evaluations to Medicare and Medicaid. BCBS says: " TEC Assessments should not be construed to suggest that the Blue Cross Blue Shield Association, Kaiser Permanente Medical Care Program or the TEC Program recommends, advocates, requires, encourages, or discourages any particular treatment, procedure, or service; any particular course of treatment, procedure, or service; or the payment or non-payment of the technology or technologies evaluated."
Of course not! Who would think such a thing! But imagine if Phrma or BIO instead of BCBS or Kaiser were running a TEC that in turn would be part and parcel of the Comparative Effectiveness Institute right off the bat. The screams about conflict would be heard round the world.
Meanwhile, here's a flavor of how slow-footed and lethal TEC transfer can be.
The munchkins at TEC central went on and on about how there was, for off-label indications of sunitinib or Nexavar (hepatocellular carcinoma), no studies were found that met selection criteria for this assessment (Who died and made them king?) That included use for renal cell carcinoma. So in otherwords the progression free survival of patients on Nexavar reported in the NEJM means nothing, as does the reports of efficacy in several other studies. (See Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007 Jan 11;356(2):125-34.) But of course " assessments should not be construed to suggest that the Blue Cross Blue Shield Association, Kaiser Permanente Medical Care Program or the TEC Program recommends, advocates, requires, encourages, or discourages any particular treatment, procedure, or service; any particular course of treatment, procedure, or service; or the payment or non-payment of the technology or technologies evaluated."
Of course not. We will leave that to the national Comparative Effectiveness Board which will collaborate with TEC to maximize research dollars.
Let's see Healthcare Renewal and the other conflict of interest police defend this one. Letting people die to save dollars...
