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Consensus Emerging on Need for New Board to Determine 'What Works' in Medicine

By John Reichard, CQ HealthBeat Editor

June 12, 2007 -- Lawmakers and witnesses at a House subcommittee hearing Tuesday agreed on the need for a public–private entity that would oversee research to determine which treatment approach works best for a particular medical condition.

"Getting reliable, unbiased comparative information is our best shot at controlling health spending while improving care and access," said House Ways and Means Health Subcommittee Chairman Pete Stark, the California Democrat who chaired the hearing. Stark said the effort should be led by the federal government, but should be "free from both industry and political influence. Let me repeat that, free from both industry and political influence."

The panel's top Republican, Dave Camp of Michigan, likewise expressed the need for a much broader effort on "comparative effectiveness" research. "While we have agencies like the FDA to determine if drugs and devices are safe, we have very little information that compares the actual effectiveness of drug, devices, and medical procedures."

Hard-nosed budget types likewise saw merit in a broad effort to promote comparative effectiveness research, saying it has considerable promise to bring down the nation's health spending growth while cautioning that it may take many years to deliver savings.

Expanded research tied to changes in payment incentives for providers and patients "offers a promising mechanism for reducing health care costs to a significant degree over the long term while maintaining or improving the health of Americans," said Congressional Budget Office Director Peter Orszag in written testimony.

"For any large-scale changes to occur, the new or expanded entity would have to generate new findings for a substantial number of medical conditions—which would take many years," Orszag said. The impact on spending is difficult to predict "because it is hard to know what the research will show," he noted.

Health economist Gail Wilensky testified that it is essential, however, to conduct such research to bring down spending growth to more sustainable levels.

Witnesses devoted much of their testimony to offering advice on how to structure and fund a new research entity to shield it from appropriations cuts and otherwise ensure stable funding while assuring the credibility of its findings.

Mark Miller, executive director of the Medicare Payment Advisory Commission, said his organization favors the creation of an independent entity to set the research agenda and disseminate findings. While various federal agencies conduct the research, "their efforts are not substantial enough or coordinated enough to affect needed change," he said.

Miller said in an interview after the hearing that MedPAC's view is that the new entity need not be a large new "bricks and mortar" federal agency but could consist of a independent board insulated from political pressures and a staff that sets the research agenda using existing public and private research programs and adds to their funding.

To avoid annual potential budget cuts in the appropriations process, the entity could have mandatory funding sources such as a tax on money collected by insurers or funding based on a small percentage of the holdings in the Medicare Trust Fund, MedPAC says.

Republicans expressed concern that the entity not be overly bureaucratic. Wilensky, a top health advisor in the administration of former President Bush, said that findings generated by the new entity should affect reimbursement levels, but not whether or not a particular service or product is covered by Medicare, for example.

"Government agencies should not be required to use or to rely solely on comparative effectiveness data to set reimbursements or make coverage decisions," said Camp.

Maine House Democrat Tom Allen testified on behalf of a measure (HR 2184) he is cosponsoring with Republican Jo Ann Emerson of Missouri that would create a "public–private funding mechanism which will pool federal resources with funds from health insurance plans and large employers with self-insured plans."

Stark didn't say what his specific legislative plans are on the issue, but praised the approach taken by the Allen-Emerson bill.

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