The Stimulus Package’s Gift to Comparative Effectiveness

The widely held belief that more IT will automatically make health care more cost-effective demands a closer look. Proponents of beefed-up IT spending, whether for CER, EMR interoperability, or other bells and whistles, rest on a short 2005 RAND Corporation study that predicted $77 billion in annual savings and improved outcomes if doctors’ offices, hospitals, and other stakeholders used the same IT platform. The study estimated that implementation would cost $1.7 trillion over 15 years and that 90% of stakeholders would use it. Practical experience says otherwise. Britain’s NHS has been trying since 2002 to connect its 30,000 physicians and 300 hospitals with an interoperable EMR, at a price tag of £2.3 billion. Seven years later and £12.7 billion over budget, the system has not yet been implemented. Compare that with 633,000 US physicians and 5708 hospitals, and confidence wanes. Closer to home, federal attempts to upgrade and unify IT at the IRS, the FBI, and air traffic control have failed.

All in all, CER is like motherhood and apple pie. In theory, no one opposes any of them, but only time will tell if putting cost/benefit price tags on drugs, medical devices, and procedures will go down easily with physicians and patients.

Summary of Health Care Spending in the Stimulus Bill

The $787 billion spending bill passed on February 13 included about $140 billion for health care. IT and comparative effectiveness spending are as follows:

• Comparative effectiveness research (AHRQ*): $300 million to AHRQ; $400 million to NIH; $400 million at HHS director’s discretion. Total: $1.1 billion
• IT (Office of the National Coordinator for Health Information Technology*): $2 billion, of which $300 million is designated for regional health information exchanges and $20 million to Department of Commerce National Institute of Standards and Technology
• IT (HRSA): $1.5 billion for health IT systems for community health centers
• Health IT (CMS): $19 billion to develop interoperable standards by 2010 that provide for the nationwide exchange of health IT for the use of information to improve the quality and coordination of care *lead agency

Source: Health Provisions in the Conference Report in the American Recovery and Reinvestment Act, Holland+Knight, 2/17/09

Evidence-Based Practice Centers (EPCs)

Since 1997, AHRQ has promoted evidence-based medicine in everyday care through the establishment of 13 EPCs. These centers develop evidence reports and technology assessments on clinical, social, behavioral, economic, and health care organization and delivery issues. The EPCs are: