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Obamacare and workers’ comp – Part 8 of 9

I’m thinking we aren’t going to get this done in 9 posts…but your attention span will likely wane long before we finish figuring out the impact of PPACA on work comp.  For today, we’re going to finish up on comparative effectiveness research’s (CER) impact on comp.

Yesterday’s post was a bit of a primer on comparative effectiveness research and covered the Feds’ investment in CER.  A couple colleagues scoffed at what they saw as my optimism about CER; their skepticism is well-founded.  For example, the 2003 Medicare Modernization Act prohibited CMS from restricting coverage of new medicines based on CER findings; if a new drug was only 2% as effective as an existing, cheap, generic drug in treating a disorder, too bad – we taxpayers would have to foot the bill.

Something even scarier happened a few years earlier.  A federally-funded study on low back pain study discredited some surgical procedures as first line treatment.  Seems sensical, right?  Let’s not start slicing until we’ve tried PT, muscle relaxants, maybe even rest, okay?

Not OK.  At least not OK to the North American Spine Society; these fine folks put on a full-court lobbying press that almost eliminated and ultimately defunded the Agency for Health Care Policy and Research (AHCPR).  Eventually the Agency, now known as Agency for Health Care Quality and Research, got a few dollars, but the lobbyists for the spine slicers were able to remove ‘policy’ from agency name.

This was a BIG DEAL.  Entities with “policy” in their name set policy; they determine what the government is going to do, what it will support, pay for, advocate, allow.  By excising that one word, the Agency was essentially emasculated.

Ultimately, the golden rule prevails – he who has the gold rules.

Implementing CER is going to be highly contentious, with extremely well-funded device manufacturers, big pharma, and their supporters capable of marshaling huge dollars (which, not incidentally, they got from charging consumers, taxpayers, and employers lots of money for their procedures/drugs/devices) to buy lots of access.

On the other side, we have the IPAB.

And that may well lead to a level playing field.


One thought on “Obamacare and workers’ comp – Part 8 of 9”

  1. It has been well documented for nearly a decade that 50% of lumbar spine surgeries (esp complicated laminectomies and fusions) fail. How was NASS able to prevail in the face of overwhelming evidence? Fewer individuals (patients) are being referred for lumbar surgery in my area over the past 4-5 years and the more prudent surgeons are not doing as many.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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