In a previous blog post, Deficit Reduction Law Makes Comparative Effectiveness Research More Important Than Ever, I talked about comparative effectiveness research (CER) and how it can lead to improved healthcare and patient outcomes.
Not everyone shares this opinion, however. During the 2009-2010 debate over national healthcare reform, CER became a point of contention and was demonized—and continues to be demonized—by those with ideological agendas and other stakeholders who may not understand how CER has the potential to improve patient outcomes and lower healthcare costs.
To those who are ranting and raving about the dangers of CER, I ask: What’s wrong with evaluating competing medical technologies’ benefits, costs and harms? And what’s wrong with informing the public about the results of CER so they can make informed decisions about their own healthcare? Shouldn’t policy decisions impacting coverage and reimbursement be informed by high-quality research findings such as CER studies, in the context of outcomes that are important to patients?
Let’s look at some of the false statements that are being made about CER:
- CER is about rationing healthcare.
- CER is about cookbook, one-size-fits-all medicine.
- CER is just about saving money.
No, it’s not.
Linking CER to rationing is a big problem. Rationing is all about limiting something someone needs because you don’t have the resources to provide it. The Affordable Care Act (ACA) expressly prohibits CER findings from being used to deny care. Here’s the specific language: “the Secretary shall not use evidence or findings from comparative clinical effectiveness research...in determining coverage, reimbursement, or incentive programs under title XVIII in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill.” Additionally, the ACA states that research findings shall “not be construed as mandates for practice guidelines, coverage recommendations, payment, or policy recommendations.” These prohibitions mean that CER cannot be used in Medicare, Medicaid, and other health benefit programs to deny care simply because of a person’s age, disability, or health status.
This ongoing demonization of CER hurts healthcare in general and ultimately all consumers of healthcare. We’re making the public feel that scientific research and informing treatment decisions through scientific research is going to result in rationing or less than optimal care. But as professionals, we all know that high-quality research is the best tool we have to determine how well one treatment works compared with another.
We all need to stand up and stop the demonization of CER. Call out and refute the false statements. Stand up for what we know to be good medicine, good healthcare, and good science. CER, when used appropriately, will give clinicians and patients actionable information based on scientific evidence, which will inform their decision making. This is never a bad thing. It’s a patient-centered approach that should result in better care for everyone.
We discuss CER and examine the benefits of incorporating an evidence-based approach to healthcare decision making in our white paper, “The Value of Evidence.” Take a look.