Doctors wary, but some in GOP look to kill one of Obama's prize initiatives

June 19, 2009
Ronald Piana
Ronald Piana

Comparative effectiveness research, embraced by Obama, is disparaged by some power-players in the opposition.

Speaking at the recent AMA meeting in Chicago, President Obama said, "Let me be clear, identifying what works is not about dictating what kind of care should be provided." Obama was referring, in part,  to comparative effectiveness research (CER), a wonky initiative close to his heart that has physicians confused and concerned about their professional independence.

The President also said: "Replicating best practices, incentivizing excellence, closing cost disparities-any bill sent to my desk that does not achieve these goals in my mind does not earn the title of reform. But my signature is not enough, I need your help doctors, because you are the health-care system."

GOP Roadblock

Besides docs, CER has some members of the GOP concerned. CER, now moving along under the pseudonym of "patient-centered outcomes research," is still a separate piece of legislature being developed by Finance Chairman Max Baucus [D-Mont.].

However, Sens. Orin Hatch [R-Utah], and Mike Enzi [R-Wyo.] are temporarily keeping CER out of the Senate Finance Committee's health-care reform bill.

Hatch and Enzi raise three major concerns with CER: age discrimination based on CER determinations; establishment of quality-adjusted life-years threshold by CMS in determining coverage for a treatment; and using CER to supplant or damage the evidence standard used by FDA.

Moreover, a bill introduced by one of CER's most ardent critics, John Kyl [R-Ariz.] would prevent HHS secretary from using CER driven data "to deny coverage of an item or service under a Federal health-care program."

If the Senate Finance Committee cannot resolve GOP complaints and get the bill moving again, it could spell the end of CER as it pertains to Obama's design for health-care reform. CER is essentially about examining what treatments are the most effective, not about limiting physician flexibility in treatment decisions or about rationing care. CER is an interesting concept, and, if employed properly, this tool could yield positive results in a system hampered by redundant and ineffective treatments.

Obama, touted as a great communicator, is somehow not getting that message across.