Stanley Feld M.D.,FACP,MACE
What is the Coordinating Council for Comparative Effectiveness?
The mission of the Council for Comparative Effectiveness will be to decide on best practices and most cost effective practices. The council will recommend cost effective treatments for diseases to The National Coordinator for Health Information Technology (NCFHIT). The NCFHIT will determine treatment at the time and place of care. It is charged with deciding the course of treatment for the diagnosis given by the doctor.
The U.S. Department of Health and Human Services announced the formation and membership of the Federal Coordinating Council for Comparative Effectiveness Research that will be funded by President Obama’s stimulus program the American Recovery and Reinvestment Act (ARRA). The council was allocated 1.1 billion dollars to set up comparative effectiveness of medical practice.
Why was this 1.1 billion dollars funded from the economic stimulus package?
The missions are based on the premise that practicing physicians do not have the ability to recommend the most cost effective medical treatment for their patients. (see executive summary)
Who are the members of the Federal Coordinating Council for Comparative Effectiveness?
The members of the committee were picked without congressional approval immediately after the economic stimulus bill was passed. They are all bureaucrats working for the government in one capacity or another. There are no practicing physicians on the panel.
“The problem remains that it still takes me 25 minutes to admit a patient using the EHR, and only 5 minutes using pen and paper. If I admit 3 patients, it adds one hour to my day. Where do I get the extra hour, and who pays me for it? So far the main beneficiaries seem to be the HMO's who can use the computer info to hassle you.”
I think Dr. Thomas stumbled on to something. The government wants to be able track in real time treatment decisions of physicians with the use of the EMR. The government can automatically decide on whether physicians are practicing best practices as defined by the council for comparative effectiveness. If physicians are not practicing best practices that are cost effective, the government will force physicians to comply using penalties.
The sentiment about this issue is express by a physician in the following You Tube. It is a worthwhile watching.
The losers are patients and physicians. The healthcare insurance industry’s profits are unharmed and government power over the healthcare system is enhanced.
There are many defects in President Obama’s point of view on how to measure quality and appropriate care. It is a monetary viewpoint. It is not from a medical care viewpoint. President Obama’s approach will lead to many unintended consequences.
Another reader wrote in response to the electronic medical record article;
Hi Dr. Feld,
Refresh my memory please, what is your perspective on how am I going to determine how good a Dr. is in the future? I want competition based on value and I know there is a wide difference between physicians in terms of skills, adopting technology and innovation etc. and results or outcomes. How do you propose I determine the best value for my money?
How do you pick a restaurant, a dry cleaner, a plumber, an electrician or a builder? Each vendor competes for your business. If the vendor does not provide satisfactory service it will lose patrons and go out of business.
Websites such as Open Table and Trip Advisor help us with making wise choices. Angie’s list has been a transformational website. It has changed the way consumers choose contractors. Consumers are very interested in expressing opinions both good and bad. Contractors read every entry and improve to become more competitive.
Physicians have to be made to compete for patients. Only he consumers of healthcare can force physicians to compete. Consumers need to be given control of their health care dollars, not the government, or a third party.
Patients should make choices based on quality of care and reputation of the physicians. Patients should be incentivized to get the most value for their healthcare dollar. Value of medical care should not be determined by a government bureaucracy using inaccurate criteria.
Websites are available for consumers to make intelligent evidence based choices. Other websites can be developed to teach consumers how to evaluate physicians and their care. These websites must be interactive. Patients can share their experiences with others. The costs of services have already been negotiated by the healthcare insurance industry and the government. These fees should be made available to patients.
I believe consumers are smart. They can drive prices down in a consumer driven healthcare system.
Physicians are not the problem with the healthcare system. It is the healthcare insurance industry and its control of the healthcare dollars.
It is a mistake for the government to make decisions for consumers of healthcare.