A U.S. agency formed to compare the effectiveness of drugs and medical devices plans a broader agenda that will study subjects such as whether care provided by nurse-practitioners is as good as that of doctors.
The agency, called the Patient-Centered Outcomes Research Institute, was created by the 2010 health-care overhaul. Republican opponents of the law say the institute will lead to government-directed rationing as it judges treatments. Representative Thaddeus McCotter, a Michigan Republican, has introduced legislation to eliminate the agency.
“Over time, you’ll continue to see them begin to creep into a rationing board,” he said in an interview last week. “They’ll have to. They’re trying to defeat the law of supply and demand.”
The institute will provide patients and doctors better information about what treatments work, said Joe Selby, the executive director, in an interview today.
“Most people understand that this is a serious and new kind of research, a serious and new mission,” he said. “When you put the issue of patients’ and clinicians’ need for information at the center, that’s just not a partisan issue.”
The agency may spend as much as $2.5 billion on research through 2019, the Congressional Budget Office estimates. Comparing treatments will be one of five broad areas the agency plans to explore, its leaders said today.
Claims that the institute may become a rationing agency are overblown, said Dan Mendelson, CEO of Avalere Health, a Washington health-care consulting firm.
“Health care services are rationed by a variety of different agents throughout the health system,” Mendelson said by phone. “The idea that you’re going to kill the concept of rationing by killing this little government agency, I think it’s far-fetched.”
Other research priorities for Selby’s agency include studying disparities in care based on race and gender, the quality of care provided by nurses and physician’s assistants and shortening the time between lab discoveries and their clinical use.
Over time, more money should be shifted to comparing treatments, said U.S. Representative Kurt Schrader, an Oregon Democrat who wrote legislation to create a comparative effectiveness research agency in 2009. The provision of the health law that created Selby’s institute echoes Schrader’s bill, which had some Republican support at the time.
‘Broader In Scope’
The research plan is “a little broader in scope” than he envisioned when he wrote his bill, Schrader said in a telephone interview. “The worry I would have is they are not going to get down to specific projects.”
He said he supported many aims of the research plan, especially investigating which care delivery systems work best.
The agency has proposed to dedicate about 40 percent of its budget to comparing treatments, Selby said. It plans to spend about $120 million this year on research grants, he said.
The plan is broad, because “there are critical questions that patients and their caregivers face in just about every area,” he said. “We start by allowing the possibility that we will study any condition and any treatment.”
The institute plans to announce an initial round of about 40 grants, drawn from 856 applications, in May, Selby said. A second round of grants, for projects linked to the research agenda, will be issued in December, he said.
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