Effort will identify which clinical procedures actually benefit patients—and are cost-effective
“Comparative effectiveness research (CER)” is likely to be one method that healthcare reformers use to establish reimbursement for different medical technologies and treatments. This will apply equally to clinical laboratory testing and pathology professional services as well as other medical procedures.
There is a compelling reason why comparative effectiveness is likely to happen on this turn of the healthcare reform wheel. Congress put teeth into the comparative effectiveness movement earlier this year when it provided $1.1 billion to support the effort in the American Recovery and Reinvestment Act of 2009.
The law also established the Federal Coordinating Council for Comparative-Effectiveness Research under the aegis of HHS. This council is to develop a framework to help government determine how to spend the comparative effectiveness budget. Experts watching these events say there is no doubt that healthcare reform will reduce reimbursement, particularly for medical procedures that contribute negligible benefits for a patient.
The $1.1 billion funding pot is divided three ways. Some $400 million is allocated to the Department of Health and Human Services (HHS) while $300 million goes to the Agency for Healthcare Research and Quality. The balance, about $400 million, is budgeted for the National Institutes of Health.
The next step in this drive to implement comparative effectiveness came in June. That’s when an HHS report to Congress outlined recommendations for spending its share of the $1.1 billion. As well, both the council and Institute of Medicine (IOM) released their CER recommendations. These reports include a draft definition of CER and an outline of research priorities.
As defined by IOM, comparative effectiveness research (CER) is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. IOM suggests that research priorities include: cancer, chronic obstructive pulmonary disease/asthma, dementia and Alzheimer’s disease, depression and other mood disorders, diabetes mellitus, ischemic heart disease, peptic ulcer/dyspepsia, pneumonia, stroke and control hypertension.
It is important for clinical laboratory managers and pathologists to at least have this comparative effectiveness research activity on their strategic radar screens. With $1.1 billion in federal funding now available, there will be serious efforts to evaluate all sorts of clinical procedures, medical devices, therapeutic drugs, and even expensive laboratory tests. That means the findings of these research teams will greatly influence how Medicare and Medicaid restructure coverage guidelines and reimbursement in the next few years. —P. Kirk