Last week we briefly discussed a few ways PPACA may affect quality of care; this morning it’s a bit about outcomes research.
To see what this has to do with comp, skip to the last couple paragraphs below.
PPACA aka Obamacare funded the Patient-Centered Outcomes Research Institute, which focuses on research intended to help individuals determine what care is best for them, what they can do to improve their outcomes, and what they can expect given their health condition and treatment choices. (details are here). The idea is pretty basic; to quote Sy Syms, “an educated consumer is our best customer.” Patients who know their health conditions, understand their treatment options and the pros and cons of those options, and are able to discuss those options with their providers are going to get better care and better outcomes – defined as what is best for them as an individual.
If an individual understands the risks and potential implications of treatment options, then that individual can make the best decision – defined as what’s best for that individual. As an extreme example, I may choose a risky and painful course of chemotherapy to treat my cancer, while you may decide that’s not for you.
In actuality, there were a lot more funds in the Recovery Bill (remember the 2009 bill?) known as ARRA than in PPACA. While most of that legislation was in the form of tax reductions, there was some spending on health care; specific to our discussion $1.1 billion was allocated to health research. This was split between three agencies; $300 million to Agency for Healthcare Research and Quality, $400 million to NIH, and $400 million for HHS itself. The money has been allocated to several areas; data infrastructure, evidence generation, evidence synthesis, research and evaluation, implementation and others. (a detailed discussion is here.
All of NIH’s and most of AHRQ’s dollars were invested in comparative effectiveness research (CER), evidence generation and translating and disseminating the findings.
Simply put, CER assesses “which interventions are most effective for which patients under specific circumstances.” NIH is looking into health care for seniors, diabetes prevention follow-up care, schizophrenia, breast imaging, chronic kidney disease, and many other conditions.
AHRQ’s work identified key gaps in evidence, found researchers qualified to fill those gaps, and funded their research. It’s hard to overstate the importance of this work; there is precious little consensus around treatment for many conditions, with wide geographic variation in treatment patterns. The Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE) focuses on pragmatic research; what actually works, in real-world clinical settings. There’s also a registry of diseases and specific medical tests, devices, and surgical procedures intended to track long-term outcomes and the viability of devices.
So, what does this have to do with workers’ comp?
There are direct and indirect impacts – for example; one of the projects funded by PCORI focused on “Long Term Outcomes of Lumbar Epidural Steroid Injections for Spinal Stenosis”; a procedure far too common in worker’s comp (if not for stenosis specifically). Another focuses on improving primary care for back pain, a third on non-surgical treatment methods for lumbar spinal stenosis, a fourth addresses obesity care in a primary setting, a fifth evaluates the best ways to disseminate outcomes research, a sixth looks at quality metrics for medical rehab, a seventh focuses on psycho-social treatment for chronic pain…
Given the oft-heard complaints – entirely appropriate complaints – from work comp professionals about the wide variation in quality of care, over-use of surgery, inability to manage chronic pain, impact of obesity, and generally crappy medical care delivered to far too many injured workers, there’s no question the funds from PPACA and ARRA will greatly benefit work comp.
As a side note, we spend about $2.6 trillion a year on medical care in the US, and less than one-tenth of one percent of that amount on objective research to figure out what works and what doesn’t.
Is it any surprise US health care is so wasteful and screwed up?