The comparative effectiveness research panel does not tell any doctor what treatment or drug they can or cannot prescribe. It looks at "comparative" effectiveness, not "cost" effectiveness. When it compares two treatments, it does not take cost into account.
The panel's only mission is to figure out which treatment is most effective for patients who meet a certain medical profile. The panel's assessment is then made public so that doctors can take it into account when making decisions. The law says that the information cannot be used as the sole consideration when deciding what to cover.
The major use of this informaton will be to put it into Health IT (information technology) programs, flagging doctors who are treating disease X or Y, providing the comparative effectiveness information on which patients are likely to benefit from treatment A or B. Doctors are free to use the information, or ignore it. Some doctors will ignore it becuase they have always used treatment A and they're just not ready to be convinced by new medical evidence. Other doctors will ignore it because they are treating a patients suffering from 3 diseases and so while treatment A might be best for most patients, it wouldn't be best in her case.
In the UK, where the government does comparative effectiveness reserach and makes it available to all doctors, doctors comply with the recommendations about 88% of the time. The government considers this a good compliance rate becuase there are always situations where there is something unique about the patient or the cirumstance. They want doctors to use their judgment when "applying" the resarch.
On the other hand, in the U.S. doctors practice evidence-based medicine, doing the things that are recommended (beta-blockers after heart attacks, etc.) only about 50% of the time. This is a very low rate of compliance with "best practice" guidelines.
On the Health Business Blog, David Williams asks New England Health Care Institute’s Valerie Fleishman to explain the definition of comparative effectiveness research (CER), describe CER provisions contained in the new legislation and discuss the challenges in disseminating new information to be used at the point of care. It’s an excellent interview which tells you everything you need to know about Comparative Effectiveness Research --and how the research will be used at point of care.
http://www.healthbusinessblog.com/?p=3884
Fleishman begins by explaining that comparative effectiveness research was first established as part of the Recovery Act in 2009 as part of the stimulus legislation. That legislation had in it a $1.1 billion investment for comparative effectiveness research and laid the foundation for what appeared in the Affordable Care Act (ACA) in March. The ACA strengthens this plank of reform by
1. Establishing a non-profit corporation called the Patient Centered Outcomes Research Institute (PCORI). That institute is set up as a non-governmental, private entity to oversee the federally funded investment that in comparative effectiveness research. The ACA says that the institute will identify priorities for comparative effectiveness research, will help to carry out the research agenda, create advisory panels, establish peer review processes, and will also in part be responsible for releasing the research findings and coordinating the research that gets done.
2. Stipulating that comparative effectiveness research must take into account different subpopulations to avoid one-size-fits-all results.
3. Setting up a trust fund so comparative effectiveness research can be funded on an ongoing basis. The $1.1 billion put in as part of the stimulus was really just for the first couple of years. The trust fund creates a pool of funding of about $600 million per year from both the Medicare trust and a fee on health plans.
4. Stipulating that none of the reports or findings can be used as mandates, guidelines or policy recommendations and that the findings cannot be used as sole evidence in making determination decisions.
But physicians are free to make use of comparative effectiveness information as they see fit when prescribing treatments for patients, and Fleishman talks about the opportunities to disseminate the information. “There is an enormous opportunity, particularly when you think about the computerized physician order entry systems and others that will be part of this. Meaningful use clearly stipulates that these systems have to have some form of clinical decision support. One of the hurdles to adoption for CER is that clinicians themselves don’t have ready access to the latest information on what the evidence says about different forms of treatments or procedures. Providing the information technology infrastructure and tools to clinicians at the point of care so they can have access to the data will go a long way toward making the data accessible.”