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'PCORI' Backers Eye PR Strategy to Cool 'Death Panel' Rhetoric

By John Reichard, CQ HealthBeat Editor

June 24, 2010 -- Insurers, drug companies and health care policy leaders got together today to talk about comparative effectiveness research, which is ramping up under the new health care law. The consensus? The effort to find out what works in medicine is going to require a good public relations strategy as much as a scientific one.

The health care overhaul law provides for hundreds of millions of dollars in research to pinpoint what works and what doesn't in medicine, through a new Patient-Centered Outcomes Research Institute to be launched in October.

Boosters of comparative effectiveness research—known as CER—on Thursday emphasized the critical importance of a good PR strategy at a Washington, D.C., conference sponsored by insurance groups, the National Pharmaceutical Council and Brandeis University.

Gail Wilensky, a Republican who ran the Medicare and Medicaid programs during the George Bush administration, told the conference to "be very clear about the challenges . . . there are many people who for a variety of reasons think this is a bad idea, and they will be only too happy to unite to have it blown off the map."

Wilensky was referring at least in part to concerns voiced by tea party activists and some Republicans that the research would be used to deny care to elderly Americans. Conservative bloggers have even used the research to justify claims that the health care law would lead to creation of government "death panels." But a broader swath of Americans grew concerned last year, too, when the move toward evidence-based medicine led a federal advisory panel to recommend less-frequent mammograms.

Moderates like Wilensky see CER as essential to avoiding wasteful spending as the nation tries to control the growth public and private health care spending. But they note that suspicions remain and that supporters will have to address them.

Sarah Kuehl, a Democratic staffer on the Senate Budget Committee involved in drafting the language creating the research program, noted that drafters of the overhaul law had to respond to such fears in creating the institute.

She told the conference that "we explored in great detail putting cost-effectiveness as the core mission of this institute. And to be quite frank the level of hostility and of fear was really quite high" about doing so now. "I think that will have to evolve over time," she added.

"The thorniest bucket of issues we had . . . to address was in relation to fears about using comparative effectiveness research by the federal government to ration care." Drafters "tried to address these fears in a thoughtful and responsible manner," she said.

"In response to fears about discrimination, we prohibited the [HHS] secretary from using the research for coverage or reimbursement in ways that discriminate on the basis of age, disability or terminal illness," Kuehl said. "We couldn't envision a world in which the research was going to be used in that way, but we had to at least address that fear."

In response to fears that the Centers for Medicare and Medicaid Services would immediately use findings from CER coming out of the new institute as the basis for Medicare or Medicaid coverage decisions, "we put in a whole layer of additional patient safeguards," she said. Drafters did so to "ensure that the way CMS used the research had to take into account things like impact on different sub-populations. They had to use the research in a thoughtful, transparent process. They couldn't use one study to make a coverage determination" but must consider research more widely.

Kuehl said that one of the ways supporters of the institute hope to foster its acceptance is though having a wide variety of participants in the health care system on the board of the institute. "We have been particularly excited about the caliber of candidates for the board . . . it's just an embarrassment of riches," she said.

Kuehl said the aim is to build public support through frequent public meetings and through a public advisory board. And a key goal is to hire an executive director for the institute who is politically savvy. The hire will have to testify in Congress frequently and will have to be skilled at explaining the importance of the program and at defending it on the Hill, she suggested.

However, during Q-and-A at the forum, an audience member prodded speakers to be more creative in their thinking about PR. In particular he called attention to anecdotes offered at the forum by speakers Carolyn Clancy and Michael S. Lauer to explain the importance of CER, saying they should be used to build a friendly public image for the research. Both Clancy and Lauer appeared to agree.

The reference was to a story told by Lauer, director of the division of cardiovascular sciences at the National Heart, Lung and Blood Institute, when he first became a doctor. Lauer said a woman with a heart attack came in for treatment, and he prescribed clot dissolvers. The woman's vital signs responded strongly and her spirits lifted: the treatment appeared to be a clinical success. Yet hours later she had a stroke and died.

CER findings since then have showed that stents to prop open clogged arteries work better than clot dissolvers, Lauer said. Were he treating the same woman today she would have received stents and wouldn't have died, he suggested.

For her part, Clancy, director of the Agency for Healthcare Research and Quality, told about the case of a colleague recently recommended for bypass surgery. The decision-making process about treatment was less than ideal because an opening on the surgical calendar for the procedure came up suddenly and the colleague was given the impression by the provider that treatment shouldn't be delayed because of the possibility of death. But the process was so hasty that the individual hadn't really had a chance to assess the pros and cons of that particular treatment. Clancy cited the case as an example of the need to improve the way clinicians are educated about CER findings and share that information with patients.

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