Monday, October 03, 2011

One for the Price of Two

If you want to grow the expense of health care delivery in America very quickly, then create two government agencies to do the same job.

From the 28 September 2011 issue of the New England Journal of Medicine, we read about a small paragraph in our new health care law that created the Patient-Centered Outcomes Research Institute (PCORI). From that same article, here's the PCORI's mission:
PCORI responds to a widespread concern (eds note: emphasis mine. Really? What about the internet?) that, in many cases, patients and their health care providers, families, and caregivers do not have the information they need to make choices aligned with their desired health outcomes.

PCORI funding is set at a total of $210 million for the first 3 years and increases to approximately $350 million in 2013 and $500 million annually from 2014 through 2019. With more than $3 billion to spend between now and the end of the decade, PCORI will support many studies encompassing a broad range of study designs and outcomes that are relevant to patients, aiming to assist people in making choices that are consistent with their values, preferences, and goals.
We should recall that there is an agency in the federal government that already does this called the Agency for Health Care Research and Quality (AHRQ). The mission statement of this agency reads:
The Agency for Healthcare Research and Quality's (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research.

(From another page on the same website:

AHRQ Agency Staff: Approximately 300.
Fiscal year 2010 Budget: $372 million.
Fiscal year 2011 Budget Request: $611 million
Research: Approximately 80 percent of AHRQ's budget is invested in grants and contracts focused on improving health care.
Ahem. Could someone please tell me why there are two agencies doing the same thing and how on earth they're different?

Wouldn't cutting one of them be a good way to save about $500 million per year for America's taxpayers?

-Wes

3 comments:

emmy said...

If either agency was doing their job, you would think that patients would be aware of them. Right now the only assistance I get is when the nurse paid by Aetna calls me once a month to tell me I need another specialist to do what my primary care doctor is already doing...Maybe cutting both agencies wouldn't be such a bad thing.

Keith said...

I believe the new agency has more of a mandate to perform comparitive effectiveness research with an eye toward eliminating those treatments which may have marginal or no benefit. More important is comparing treatment in terms of cost/benefit that includes an actual cost comparision (in monetary terms) as well. An example would be comparing various treatments for low back pain where you have conservative forms of treatment that can be relatively inexpensive on one end of the cost spectrum and various forms of spinal surgery on the other end. Is there an algorithm that provides maximal benefit at minimal cost?

AHQR has been more focused on quality measures and supporting studies for health care delivery models such as the medical home model and ways to deal with health care disparities (lack of access in low income communities for instance).

Would agree that many of their duties overlap and that it would make sense to put all this activity under one roof, but the best way of differentiating is that one has a mandate for increased quality and delivery of care and the other is driven by value (getting the best bang for the buck).

Tim Hulsey, MD said...

Keith said..."getting the best bang for the buck"
That certainly always overshadowed getting the best bang for the patient in my medical training.
Not!
It's just a mandate to mandate what treatment a patient can get, since those with the same diagnosis are always the same, right?
Not!
I'm sure it will remove all of our liability for not doing the best for the patient because of the mandate.
Not!
Wonder how much liability insurance they will mandate that Watson carries?