Dare to Compare

The Hospitalist. 2007 September;2007(09):

September 1, 2007|The Hospitalist

A new concept on Capitol Hill could reshape physicians’ treatment choices: comparative effectiveness research, or CER.

CER is a set of standards for examining the effectiveness of different therapies for a specific medical condition or set of patients to determine the best option. It may involve comparing competing medications or analyzing treatment approaches, such as surgery, devices, and drug therapies.

The healthcare community—and Capitol Hill—should keep an eye on CER.

“We need to look at evidence-based medicine and see what is the most effective treatment,” says Andrew Fishmann, MD, FCCP, FACP, co-founder of Cogent Healthcare and director of intensive care at Good Samaritan Hospital in Los Angeles. “The answer may also be the most expensive, but other factors such as decreased length of stay and fewer complications can help bring that cost down.”

One example that CER might address is back surgery—an issue many physicians cannot agree on. “There are billions of dollars spent on back surgery that may not be necessary,” Dr. Fishmann points out.

CER could ultimately provide guidelines that would standardize treatments for all types of conditions: “A big organization like Cogent would like to think that a patient with pneumonia receives the same treatment whether he’s in California or in Mississippi—but there are many reasons this is probably not true,” says Dr. Fishmann.

POLICY POINTS

Heart Data Online

You can now review data on mortality rates for heart attack and heart failure in hospitalized Medicare patients on the government’s Hospital Compare Web site at www.hospitalcompare.hhs.gov. Available data include 30-day risk-standardized mortality measures for patients with hospital discharge diagnoses of acute myocardial infarction or heart failure for all acute care hospitals in the U.S. from July 2005 to June 2006.

Measure Your State

Fifty-one new data snapshots—for every state plus Washington, D.C.—are available from the Agency for Healthcare Research and Quality (AHRQ). The snapshots measure healthcare quality in three contexts: by types of care (such as preventive, acute, or chronic), by settings of care (such as nursing homes or hospitals), and care by clinical area (such as care for patients with cancer or respiratory diseases). The data were collected through 129 quality measures, each of which evaluates a different segment of healthcare performance.

Visit statesnapshots.ahrq.gov.

More Money for AHRQ

In June, the Senate Appropriations Committee approved an increase of $10 million for FY 2008 funding for the AHRQ, bringing total funding to $329 million. Additional legislation in the House would add $10 million to that.

MedPAC Favors MS-DRGs

The Medicare Payment Advisory Commission (MedPAC) has urged the Centers for Medicare and Medicaid (CMS) to adopt the Medicare Severity Diagnosis-Related Groups payment system, or MS-DRG, proposed for FY 2008, but recommended some changes. These include refinements to proposed methods for estimating cost-based weights. Online at medpac.gov/documents/061107_IPPS _rule_comment.pdf. —JJ

CER So Far

The Medicare Modernization Act of 2003 gave CER a jumpstart with $65 million in appropriations and authorized the Agency for Healthcare Research and Quality (AHRQ) to conduct research.

“Since 2004, [the AHRQ has] received $15 million a year for CER,” says Emily Rowe, director of government relations for the Coalition for Health Services Research in Washington, D.C., and a member of the Friends of AHRQ coalition. “They’re pretty limited in what they can produce on that budget, but to date they’ve done some interesting work.”

That work includes eight published reports on treatment options for breast cancer, gastroesophageal reflux disease (GERD), cancer-related anemia, low-bone density, depression, and more, with 20 additional reports “in the pipeline,” says Rowe.

All available reports can be downloaded from https://effectivehealthcare. ahrq.gov, where results have been published in separate versions for physicians and consumers.