Remember “death panels”?
It was a Sarah
Palin creation based on the provision originally in the healthcare reform
legislation that became Obamacare. She
successfully morphed the intent to pay physicians for end of life counseling
into a government program to decide which seriously ill people would be treated
and which would be deemed unworthy and have medical treatment withheld.
Because of all the uproar Palin
created, Congress struck the end of life counseling from the bill. But Palin wasn’t satisfied and has pointed to
the law’s Independent Payment Advisory Board as the “death panel”. The IPAB will eventually make recommendations
to the White House and Congress on ways to control Medicare costs.
Palin calls these future
recommendations, which might be developed after 2018, the “subjective rationing
of care”. In other words—“death panels”.
But helping to fuel Palin’s calculated public paranoia was another part
of Obamacare calling for comparative effectiveness research to give us better
healthcare while controlling costs. The
law even set up the Patient-Centered Outcomes Research
Institute to focus the effort to conduct the needed research to determine the
effectiveness of medical options and provide this information to healthcare
provides.
The story in the Contra
Costa Times (below) explains why comparative effectiveness research is
important not only for controlling healthcare costs but for better medical
treatment. Critics also have expressed
concern that this research will lead to rationing.
But the Kaiser
Permanente has used comparative effectiveness research for decades for cost
control and better health of its over 8 million health plan members across 9
states and the District of Columbia.
No
one apparently has charged Kaiser Permanente with using “death panels” but that’s
probably because it doesn’t provide services in Alaska.
-------------------------------------------
Contra Costa Times
June 10,
2013
Kaiser research method has potential to transform U.S.
health care system
It was a nuisance and David Gassman
put it off for three weeks, but he finally put a little stool sample into a
tube and mailed it to a Kaiser Permanente lab.
It's a good thing he did. The test
indicated he had colon cancer.
The 68-year-old Oakland resident,
who is recovering from surgery, can thank an emerging field known as
"comparative effectiveness research." It's an idea that sounds so
obvious it's hard to believe it isn't already routine: Rather than simply
analyzing whether a drug or treatment method works, researchers compare options
to determine which ones do the best job for patients.
Many experts say the approach has
such potential to transform the U.S. health system that the federal government
will spend $3.5 billion on it through 2019 under national health reforms.
After Kaiser's comparative research
revealed that a low-cost, mail-in stool test is more effective than previous
stool tests, the health system began offering it widely to patients in the
mid-2000s, aware that many would find it more appealing than an intrusive
colonoscopy.
Kaiser screening rates jumped from
less than 45 percent to nearly 85 percent, potentially saving hundreds of
lives.
Critics have complained that
comparative effectiveness research could lead to health care rationing. But the
Kaiser Permanente Division of Research in Oakland with 550 employees has been
doing it for decades to improve patient care and is considered a national
leader in the field.
Why is it needed?
Drug companies spend millions of
dollars testing their next blockbuster drug, and the federal government devotes
large sums to studying diseases, but little is spent on research to help doctors
and patients answer such crucial questions as:
·
Does a costly new drug work better than the cheaper medication that has
been around for decades?
·
Should I spend thousands on a painful back surgery or would physical
therapy work just as well?
·
What offers the best results for treating a sleep disorder?
"Patients and clinicians often
are forced to make decisions without good evidence," said Dr. Joe Selby,
executive director of the Patient-Centered Outcomes Research Institute, an
independent nonprofit that Congress set up to oversee the program.
The United States has had major gaps
in comparative effectiveness research, said Dr. Tracy Lieu, who directs
Kaiser's Northern California research division. "Drug companies are not
particularly eager to fund studies that might find that their drugs should be
used on fewer patients," she said.
Although Gassman had never heard of
such research, it may have saved his life. He had a sigmoidoscopy several years
ago and he says it could have been several more years before his doctor
recommended a colonoscopy. The mail-in stool test, which Kaiser sends out
annually to its 50- to 75-year-old members, enabled doctors to catch his colon
cancer early.
If the test finds blood in the
stool, a sign of cancer, the results are confirmed with a colonoscopy. Gassman
had surgery in May and now jokes that he has a semicolon.
"We have to continue monitoring
the situation to be sure it doesn't return, but supposedly we got it all,"
he said.
Kaiser has changed its colon cancer
screening policies over the years as a result of comparative effectiveness
research. In 1993, when many patients weren't being screened, Kaiser invested
millions of dollars to offer sigmoidoscopies, which are similar to but less
invasive than a colonoscopy, after finding that it could save lives. The study
was headed by Selby, who was director of Kaiser's Oakland research division
before he was tapped to head the national institute.
But in part because many patients
find sigmoidoscopies uncomfortable, Kaiser could never get its screening rates
above 45 percent.
A later Kaiser study found a new
version of a stool test identified more cancers and polyps and had fewer false
positives than older stool tests, said Dr. James Allison, an emeritus
investigator in Kaiser's research division. Screening rates soared when Kaiser
made the mail-in stool tests widely available in the mid-2000s. Today, Kaiser
urges its members to take a yearly stool test, or a colonoscopy every 10 years,
or a sigmoidoscopy every five.
The screening has had results:
Kaiser found 331 cancers among the 340,000 stool tests it analyzed for its
Northern California members in 2011.
In one of its latest projects,
Kaiser teamed with UC San Francisco to look at the best way to control high
blood pressure in African-Americans, who have much higher rates of the
condition than whites.
They will examine whether giving
African-Americans a higher dose of diuretics or telephone sessions with a
health coach can be effective, said Dr. Stephen Sidney, director of Kaiser's
stroke prevention research program.
These are the kinds of effectiveness
questions that will be pursued with the federal research money at institutions
around the country. Congress allocated $1.1 billion for comparative
effectiveness research in 2010 in the federal stimulus bill and set aside $3.5
billion more in the Affordable Care Act.
Critics said they fear such research
could lead to health care rationing if the government uses the results to ax
effective treatments simply because they cost too much.
To address such criticisms,
legislation discouraged the new institute from doing cost comparisons.
That has erased many of the concerns
initially raised by groups such as the Partnership to Improve Patient Care, a
private organization formed in 2008 that includes representatives of drug
manufacturers, device-makers and patient groups. Now the group's chairman,
former Rep. Tony Coelho, a Democrat who represented the San Joaquin Valley
area, said he wants to make sure that patients are involved in the new
institute's decision-making and that doctors and patients can understand the
research findings.
The new institute has patients on
its advisory committees and people can suggest research questions on its
website, Selby said.
To avoid having its findings sit on
a shelf, he said, the institute will work to see "that decision-making
actually changes and health status improves."
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