Retrospective analysis of claims data to evaluate outcomes. Comparative evaluation of similar treatments to determine which approach cost-effective Shifting public and private dollars to the lowest-cost providers to reign in health care spending. That’s the gist of the so-called “evidence-based” medicine movement which has spread like the Hanta virus through hospital, managed care and state policy circles to create price-based prescription drug formularies that limit or encourage the use of lower priced medicines based on these sorts of exercises described above. Managed care and liberal thinks have been particularly aggressive in supporting EBM and has helped fund the Oregan center that is cranking out studies demonstrating that no one medicine is any better than any other for most people.
Now these same groups are howling now that they Medicare is giving them a taste of their own medicine. According to the NY Times (and I have will have to come to my own conclusion after further research) Medicare is developing a a new system of payment “… based on hospital costs, rather than on charges, and would be adjusted to reflect the severity of a patient’s illness. ” But the data for doing so will be based on a retrospective analysis of claims data which by definition cannot keep up with changes in technology. Hospitals and managed care plans are complaining — and so are some member of Congress probably prompted by the same interests — because they are afraid it will cut reimbursement for many procedures and technologies. A sample of the comments:
J. Brian Munroe, vice president of WellPoint, one of the largest private plans, said he feared that the Medicare changes “will introduce a significant amount of disruption to the commercial health insurance marketplace, driving up health care costs and causing marketplace confusion.”
Dr. Alan D. Guerci, president of St. Francis Hospital in Roslyn, N.Y., said the new formula would cut Medicare payments to his hospital by $21 million, or 12 percent. “It will significantly reduce payments for cardiac care and will force many hospitals to reduce the number of cardiac procedures they perform,” Dr. Guerci said.
According to the NYT…”drug and device makers have been lobbying Congress and the Bush administration to delay the changes to allow further analysis. Device makers are scheduled to meet with top White House officials this week. More than 200 members of Congress have signed letters supporting a one-year delay. “
But I thought evidenced based medicine was a good thing. Wellpoint was leading the way in integrated EBM into its formulary. Ditto Medicaid and many hospitals. Now, when the same interests who were using it to swing an axe at drug companies see that EBM is a double edge sword they are screaming for help and wringing their hands about horrible it is.
What’s the DRG for hypocrisy?
A hospital now receives the same amount for a patient with a particular condition, like pneumonia, regardless of whether the illness is mild or severe.