Can We Get Around Rationing When It Comes to Comparative Effectiveness Research?

The concept of "comparative effectiveness research" has been mentioned so many times during the Senate Finance Committee's healthcare reform deliberations in recent months that members suggested that they think of a less controversial—and even easier—name.

Perhaps "patient-centered outcomes research"—PCOR for short—or maybe even "Fred," Committee Chairman Max Baucus (D-MT) joked earlier this week at a Brookings Institution symposium on implementing comparative effectiveness research.

"But whatever we call it, one thing is certain: we need to address the very real concerns that this research might be used to 'ration' healthcare," Baucus said. "People talk about cost effectiveness versus clinical effectiveness. People talk about whether the research can be used to make coverage decisions. These concerns boil down to one underlying issue: rationing."

Comparative effectiveness research—or the process of looking at the relative strength and weaknesses of various medical interventions—has emerged as a "great transformative issue" in the healthcare debate, Baucus said. "It is serious and needs to be addressed with integrity."

So can we get around the "R" word when it comes to comparative effectiveness research? Well, possibly. In trying to meet the issue head on, Baucus suggested three main ideas that will have to be up front and center when discussing and using comparative effectiveness research in order to get acceptance of the idea among the public. They are:

• Make sure the research is patient-focused, taking into consideration patients' preferences for how they want the treatments to work. Patients should be actively involved in setting the research priorities along with designing the research studies. The studies must be relevant to patients. "In short, patients must be at the center of the questions about medical care that we want answered," Baucus said.
• Next, all practicing physicians need to be at the table—and not just research physicians, but those who use and prescribe medical care everyday. They know what questions to ask. They can be key to making the research meaningful for decisions they make with patients, Baucus noted.
• Third, create safeguards when it comes to the use in federal healthcare programs. Medicare and Medicaid should not be allowed to create automatic links to any single study. These programs need to be open, transparent, and thorough in how they use patient-centered research. Nothing should be done behind closed doors without public input.

So far, that's off to a good start. But to give more structure to comparative effectiveness research, more might be needed, such as giving a physical presence to the concept.

Baucus and Sen. Kent Conrad (D-ND) reintroduced a bill this month that would create a nonprofit corporation—called the Patient-Centered Outcomes Research Institute. The goal of the institute—which would be established as a private, nonprofit group—would be to review and generate scientific evidence and new data on treatments and best clinical outcomes related to diseases, disorders, and other conditions.

The senators had introduced similar legislation in the previous Congress. But the new measure would require the Centers for Medicare and Medicaid Services to meet specific requirements before using research, including comparative effectiveness research studies, in making coverage decisions.

Comparative effectiveness research will likely play an important role during the healthcare reform debate—and many years after that. So no matter whether it is called "CER" or "Fred" or any other name, the term needs to be carefully defined for this generation, and the ones that follow, to avoid the presence of that "R" word.