Health Provisions Slipped into Stimulus Package

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The $1.1 billion earmarked for comparative effectiveness research remained in the bill that President Obama will sign. The House conferees also insisted on keeping the phrase "comparative effectiveness" throughout the authorizing language, removing the Senate's insertion of the word "clinical." The report language did note its removal was "without prejudice."

However, the conferees do not intend for the comparative effectiveness research funding included in the conference agreement to be used to mandate coverage, reimbursement, or other policies for any public or private payer. The funding in the conference agreement shall be used to conduct or support research to evaluate and compare the clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition.

We saw a perfect example last week of how comparative cost-effectiveness analysis can be coupled with comparative clinical-effectiveness analysis to provide useful guidance to health practitioners, patients and payers faced with a confusing array of alternatives in one particularly crowded area of health care: colon cancer screening. CMS made a preliminary decision not to pay for virtual colonoscopy.

http://www.nytimes.com/2009/02/13/health/policy/13colon.html?scp=1&sq=colonoscopy&st=cse

CMS concluded, based on a comparative cost- and clinical-effectiveness analysis conducted by AHRQ, that taking its costs into account, virtually colonoscopy made no sense either medically or economically. Not all comparisons merit a cost-effectiveness analysis. When one drug, device, surgery or other medical technology is clearly superior to another, then the U.S. health care system, which operates without cost controls, pays for it. This legislation reinforces that approach.

Yet as anyone with even a passing familiarity with the medical science and medical economics literature understands, comparisons are rarely black and white. Most medical technologies only help a fraction of patients. Most medical technologies have some risks associated with their use. Comparative cost-effectiveness analysis is an important tool for accurately evaluating those benefits and risks.

Source: GoozNews

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Specializes in NICU Transport/NICU.
"You Liberals" LOL I love it ;-):yeah:

Would you prefer Socialists? How about whining little babies? How about Drain On Society? Better yet, why don't you take your mind off of your Wealth Envy and listen to this: http://www.youtube.com/watch?v=VJdu-HCyGZE&feature=related That basically sums up the reason why our president is who he is and where this country is heading.

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I work in dialysis which is extremely costly. Some of my own comments:

1. Is it cost effective to start dialysis on a 97 y/o?

2. Should a pt who has had one renal transplant which failed due to his cocaine abuse, be allowed to receive another transplant?

3. Should a pt who refuses to stop smoking and take their HTN meds, be allowed to have a transplant?

I see such an abuse of our system it is staggering.

All you say is worth examining.

However, how dishonest and NOT TRANSPARENT is it of OUR lawmakers to pass a HIDDEN healthcare bill without reading it, allowing the public to know about it, and allowing NO discussion of it? How dishonest is it to proclaim a crisis that must be acted upon without ANY scrutiny of what is in this bill and claim it to be "stimulus". Is that the way to reform healthcare? It is hypocritical and goes against the very fiber of our republic. CHANGE? This is just more corruption.

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Specializes in Critical care, tele, Medical-Surgical.
I already get "guidance" from my health plan: yearly mamography, medication refill reminders, eligible for initial bone density testiing as over 50.... DH got his prostate screening reminder. My PCP has been ahead of the curve using an EMR for about 9 yrs now: he is often ahead of health plan in giving me RX for screening exams....like many Americans due to work delay in getting some tests scheduled.

HOWEVER, being in homecare, I see too many physicians that are carrying huge patient loads and only focus on cheif complaint during vist, never check diabetics HgbA1C, check their feet -- (homecare RN's find many foot ulcers) or recommend that patient get testing done so I see results opposite side of arguement: advanced conditions that could have been minimized/prevented with early testing if PCP had only offered/provided.

When I check patients homecare eligibility, have access to screen where screening tests last paid for listed: ~ 60% are blank for prostate + mamography exams in 60-80 YO.

Any provider signed up for CMS listserve been getting bombarded 2-3x week with CMS message to include screening exams, offer flu/pneumonia vaccine, diabetes tesing supplies covered under Medicare etc so fully expected to see this type language in next healthcare legislation as part of push to reduce long term treatment costs.

All those tests now covered by Medicare/Medicad will being in patients into labs, radiology, outpt depts therefore increasing facilites healthcare activity + keeping healthcare staff employed: find a problem now obligated to treat it.

Doctors and patient always have the last word to accept/reject based on INDIVIDUAL's unique healthcare needs.

Please read the bill.

It is attached.

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Specializes in PACU, ED.

Herring, thanks for providing the text. I didn't find limitations in the text but did find funds for preventive medicine which is one thing I'd emailed to the White House after the inaguration. I don't know if my message had an effect or if they figured out that one on their own. However, I do encourage everyone to email the Whitehouse when they have beneficial ideas or constructive criticism. (Of course, in accordance with free speech you are free to send non-constructive complaints too.)

Anyway, it's very easy. Go to the the Whitehouse.gov website. There is a like to contact them. You can send a 500 character message very easily or call on the phone number if you prefer.

I didn't vote for Obama but I will give him suggestions for things that I believe will help America.

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$21 billion to provide a 60% subsidy of health care insurance premiums for the unemployed under the COBRA program; $87 billion to help states with Medicaid; $19 billion to modernize health information technology systems; $10 billion for health research and construction of National Institutes of Health facilities.

One aspect of the monies was to fund a comparative-effectiveness program to assess whether or not treatments (mostly the newer targeted regimens) are really better than older treatments. Decisions are being made about what cancer treatments patients can actually afford.

Comparative research is not rationing health care. The research funding doled out in the recent Stimulus Package would go to the National Institute of Health, the Agency for Healthcare Quality and Research and the Centers for Medicare and Medicaid Services to focus on producing the best unbiased science possible.

Comparative research has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the "industry" wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it. Just about the way they are controlling data now.

Comparative-effectiveness research is not something for patients to be afraid of. It can help doctors and patients, through research, studies and comparisons, undertand which drugs, therapies and treatments work and which don't. Nothing in the legislation will have the government monitoring treatments in order to guide your doctor's decisions. Doctors will still have the ultimate decision, along with the patient.

Yet as anyone with even a passing familiarity with the medical science and medical economics literature understands, comparisons are rarely black and white. Most medical technologies only help a fraction of patients. Most medical technologies have some risks associated with their use. Comparative cost-effectiveness analysis is an important tool for accurately evaluating those benefits and risks.

Another aspect of the monies is the funding for health information technology in the recovery package is projected to create over 200,000 jobs and a down-payment on broader health care reform. Converting an antiquated paper system to a computer system by making the health care system more efficient.

The Congressional Budget Office has estimated that one-third of $2 trillion spent annually on health care in America may be unnecessary due to inefficiencies in the old system such as exessive paperwork. Investing in infrastructure like Health IT would help improve the quality of America's health care.

Currently, fewer than 25% of hospitals and fewer than 20% of doctor's offices employ health information technology systems. Researchers have found that implementing Health IT would result in a mean annual savings of $40 billion over a 15-year period by improving health outcomes through care management, increasing efficiency and reducing medical errors.

Investing in Health IT would also help primary care physicians who often bear the brunt of tech implementation without seeing immediate benefits, affording the infrastructure for expanison. Some PCPs are ahead of the IT curve but cannot afford the richness of its expansion. They need this important infrastructure.

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Specializes in Critical care, tele, Medical-Surgical.

I'm leery because I've seen electronic medical records poorly designed and/or implemented.

It can be helpful or frightful.

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I haven't read through the whole long thread to see if others have similarly debunked, but I have to point out that the article on which this is based is a complete and total fabrication. What is in the simulus package is some some money to provide studies of relative efficacy of various treatments - no hint anywhere of government controls. The lies about what is there are being promoted by drug and device companies afraid that the studies might show their products are not worth the money they charge for them. In addition to that, there is a somewhat larger amount of money to promote the development of healthcare IT. I'm not at all convinced that better IT is the panacea some think it is, but there is nothing whatsoever in the bill about government controls on what treatments doctors can use. Those companies who are afraid of finding out which treatments work best perhaps have something to hide?

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I use CPRS all the time it is very intuitive and straightforward. (It does have flaws that the developers are working on resolving. Usually of the which John Smith does this order pertain to. ) One of the advantages of CPRS is it allows a veteran to be cared for at any VA and there records are instantly portable between facilities.

The reality is that Hospital/clinic systems have been dramatically regionalized over the past 15 years. Integration of health records reduces duplication and reduces the chance of an error.

The bill should have included language that any health care facility system can have CPRS for free along with patches.

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Would you prefer Socialists? How about whining little babies? How about Drain On Society? Better yet, why don't you take your mind off of your Wealth Envy and listen to this: http://www.youtube.com/watch?v=VJdu-HCyGZE&feature=related That basically sums up the reason why our president is who he is and where this country is heading.

I'm not sure how name calling advances the cause of health care reform. Frankly, I found the youtube video and the attached commentaries to be racist. If you can post academically sourced articles to support your position than perhaps we can have a conversation that helps us as a nation to work together to solve our problems. As it is the "contributions" you have made have done nothing to move the discussion forward in a civil manner. As a professional we have to be able to treat each other with dignity and respect.

Insurance by definition is a social product. That means that none of us pay the full cost for our care at some level we all contribute to each others care through our contributions. As it is we are spending 350 BN a year for administrative costs (profit) and unnecessary care. Isn't it a better idea to study health care to figure out what really works and tailor our reimbursement systems accordingly?

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Specializes in EMS, ER, GI, PCU/Telemetry.
Would you prefer Socialists? How about whining little babies? How about Drain On Society? Better yet, why don't you take your mind off of your Wealth Envy and listen to this: http://www.youtube.com/watch?v=VJdu-HCyGZE&feature=related That basically sums up the reason why our president is who he is and where this country is heading.

we like to have a spirited debate here on AN.

insults, however, are not welcome.

i have no wealth envy and i don't see myself as a drain on society simply because i do not agree with your ideologies. you don't know anything about us individually and it is unfair to blanket everyone who is a liberal democrat into such demeaning terms.

we have to have respect for each other in order for our debates to be meaningful.... insults just put people on the defense and make no one want to hear what you're saying.

play nice in the sandbox.

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Specializes in NICU Transport/NICU.
I'm not sure how name calling advances the cause of health care reform. Frankly, I found the youtube video and the attached commentaries to be racist. If you can post academically sourced articles to support your position than perhaps we can have a conversation that helps us as a nation to work together to solve our problems. As it is the "contributions" you have made have done nothing to move the discussion forward in a civil manner. As a professional we have to be able to treat each other with dignity and respect.

Insurance by definition is a social product. That means that none of us pay the full cost for our care at some level we all contribute to each others care through our contributions. As it is we are spending 350 BN a year for administrative costs (profit) and unnecessary care. Isn't it a better idea to study health care to figure out what really works and tailor our reimbursement systems accordingly?

If you will look at my whole thread, you would notice that I was responding to someone attacking me. All of my previous threads have been about the Health Care Package. As far as the audio being racist, it is only racist if you want it to be. My point was to prove where the supporters of Obama are coming from. The majority of them are not in this to help their fellow Americans. They are in this for self-gain. Whether that be in Health Care or handouts. You'll have to excuse me if I don't feel bad about people who don't want to work and want to take money from the Wealthy, not having any healthcare.

I think it is sad that some people in this country don't have any healthcare. Especially at the hands of an insurance company. I have no pitty for people who sit on their butts and expect everything for free. And frankly, as a professional, I'm worried about what government control of healthcare will do to the level that we provide and their control of our incomes. The government has yet to show a stellar record of anything they control.

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