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Former Congressman Dr. Phil Gingrey provides public policy and government relations counsel to clients on a variety of issues. Here at Phil on the Hill, Phil draws upon his long career in public service to provide perspective and context on policy topics such as health care, the federal budget, annual appropriations, regulatory reform, and life sciences.



The Value of Comparative Effectiveness Research

Tuesday, August 15, 2017

Over 32 years in the practice of medicine, I relied upon no single factor to make a treatment decision for my patients.

I acutely observed each patient’s symptoms against her history, living circumstances and overall health. I kept up with journal articles, official guidelines and the latest science. But these empirical factors were always considered in the context of my training, education, experience, patient input and something else — gut instinct.

There were many times as an OB/GYN that I could have prescribed a treatment that would have been in line with standard practice, but my intuition told me to do something else. A doctor’s blending of knowledge and instinct is something that no chart or computer can yet duplicate.

This experience comes to mind now that physicians can utilize an emerging resource to inform their decisions — Comparative Effectiveness Research (CER) — which compares the national outcomes of tests, treatments and procedures. CER is a powerful tool, one that can identify unexpected effectiveness from novel treatments and reveal deficiencies in established practices.

I recently had the honor and pleasure of speaking about the history, value and role of CER with former Senator Kent Conrad (D-ND), who was a lead champion of CER during his time in the Senate. The event, a panel discussion, was hosted by the Bipartisan Policy Center. In preparing my remarks for the discussion, I took quite a bit of time reviewing the research funded by the Patient-Centered Outcomes Research Institute (PCORI), an independent, non-profit research agency authorized by Congress to conduct CER. I specifically looked at PCORI studies pertaining to prostate cancer, ovarian cancer and preeclampsia.

In each domain, CER identified risks that doctors and patients need to understand and should include in their discussions when making treatment decisions. For example, concerning the 3 million American men with diagnoses of prostate cancer, PCORI found that surgery and radiation treatments both carry elevated risks of side effects over the simple strategy of watchful surveillance. 

This PCORI study doesn’t tell doctors or patients which treatment is best. In many cases, the risk of cancer may still outweigh the patient’s concern about treatment side effects. Instead, the study offers information for men, and their physicians, to make informed decisions. Used in this way, CER can empower doctors and patients alike to make individualized decisions based on national studies. 

In my congressional career, my support for CER was balanced against my determination to protect the judgment and discretion of physicians. In one mark-up in the House Energy and Commerce Committee, I stood with members of both parties to prevent CER and cost-effectiveness data from being used to determine which treatments doctors can offer. A bipartisan group of us were concerned that CER would be used to ration care — perhaps through a body like the UK’s National Institute for Health Care and Excellence. Senator Conrad appreciated this concern and played an instrumental role in the final version of the CER- and PCORI- related provisions in the enacted Affordable Care Act; he deftly crafted a compromise to ensure that the findings would be available to inform clinical decision-making and could not be used for government insurance coverage and payment policies.
 
More than seven years later, I am impressed with the PCORI studies I reviewed and am encouraged by the manner in which the information is being disseminated and leveraged – to the benefit of patients, physicians and the health care system, and not in an autocratic way. To support CER is to support patient-centered care and the advancement of physician knowledge in a way that promotes good practice and allows flexibility, patient preference, and the leveraging of physician experience and instinct. That is a winning combination I would prescribe.