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A Modest Proposal: Pay More for Care Only if It's Better



By applying comparative effectiveness research results to federal reimbursements, only medical services with higher relative value would justify higher payment, says the author of a Health Affairs study.



1 comments on "A Modest Proposal: Pay More for Care Only if It's Better"
Susan Collingwood (10/21/2010 at 3:01 PM)

This proposal sounds like a fantastic way to gut medical innovation. True, evaluation of care results needs to be done. HOWEVER, the Randomized Clinical Trial model has *significant* flaws. In the cancer example cited, it often takes 10 YEARS or more to get meaningful data on "ultimate outcomes". Further, the proposal basically suggests physicians request patients to voluntarily subject themselves, for example, to *ADDITIONAL RADIATION* (that we already know is bad for them[INVALID]that's why we strive to limit it!) on the *off chance* that the additional radiation we know the patient will receive in conventional radiation therapy is not that harmful, despite the known improvement in reduced tissue irradiation in IMRT, and huge improvement in proton beam. This does not, of course, even take into account the reasonable expectation that the IRMT or proton beam therapy may actually have a better outcome in curing the cancer! Further, in evaluating the treatment, the author's proposal suggests that *without* a RCT, one is free to ignore other evidence (like physics involved), since it's not a RCT with a defined endpoint. Because newer care is often more (or even much more) expensive than existing care (due to additional costs of technological innovation, or even needed physician time [see the comparison in Dr. Gawande's book, "Better", between the care delivered by the CF programs[INVALID]and note the mortality experienced), the threat of not having reimbursement until a RCT (in the case of the cancer sited, of at least 10 years) is completed is VERY likely to entirely stifle medical innovation.