PCORI – is this a worthwhile expense on your health plan or another example of Government bureaucracy and waste?

Evaluating the benefit of PCORI, the Patient Centered Outcomes Research Institute, relative to the impact on healthcare costs and efficacy of current treatment protocols may be impossible. One’s opinion may well be determined by your baseline feelings about redundant government programs, government bureaucracy, or even political positions.

One could also add data security to the list of concerns. More about that below.

Honestly, it is hard to justify the added expense to health plan costs or the benefit to healthcare practitioners and their patients. If the goal is to study comparative outcomes for current practice protocols then how will the analysis be delivered. One problem is that the PCORI has no authority to implement any findings nor to direct healthcare practitioners to modify their practices. Another problem may be human nature, that being, Doctors wanting to practice in their own experienced manner.

We all want affordable high-quality healthcare with the latest and most effective technology. There’s no argument there. But, given the history of what happens in the private sector when government intercedes don’t we have the obligation to investigate and challenge the established bureaucracy?

There are already at least two notable government agencies that experts say could incorporate the PCORI objectives with in their current structure. One is the National Institutes of Health and another is the Agency for Healthcare Research and Quality,

The Agency for Healthcare Research and Quality has the stated mission of “making health care safer, higher quality, more accessible, equitable, and affordable”. It is considered small by federal government standards with a budget of about $440 million. Believe that, small at $440m? Anyway, the mission for the AHRQ sounds like something we want so why couldn’t it dish out the $3.5 Billion expected to be awarded by PCORI?

Plus, the GAO (Government Accountability Office) states that the PCORI won’t go through a review by any independent outside entity until 2020, after the program has run it’s course, awarded an expected $3.5 billion and PCORI is no longer operative.

So, one must ask, is PCORI a worthwhile venture or just another government program scheduled to end but destined for in perpetuity?

After reviewing many of the awards given to date it is easy to lean toward the obvious: that PCORI has both great waste and great potential, depending on one’s fiscol perspective.
Let’s look at a couple PCORI awards:

  • One project looks at how doctors can create a “Zone of Openness” with patients which was part of $61 million in awards. Were you wondering about your doctor’s “Zone of Openness” the  last time you were waiting to see the doctor, dressed in your paper robe, sitting on that awkward metal bench covered in butcher block paper?
  • $14 million for a study on the appropriate dose for aspirin being taken to prevent heart attacks. Too much and you could bleed to death. How long have doctors been practicing this treatment protocol and they don’t know the correct dose?
  • $500,000 went to AHIP (America’s Health Insurance Plans) to “build and maintain support from health plan leaders” and to “identify important gaps in availability of health insurance administrative data”.
    A spokesman for AHIP stated that sharing health plan data is “complex” and “requires a significant amount of review and expertise from the industry”.
  • $249,000 went to Society of General Internal Medicine for a 2 year program, as stated “to help us develop a better understanding of the attitudes and knowledge of our membership”.
  • I’m not kidding!

Will we see any demonstrative results from the $3.5 billion in research awards expected to be doled out? Good question! Supporters say that we will see the results in articles published in medical journals and through presentations , seminars and other public dissemination. Since the PCORI has no authority the information obtained will not be sent out as directives to be followed. That part may be good.

In fact, some legislators and professional groups are concerned that the government, particularly CMS, may try to use the PCORI results to limit or restrict healthcare services to citizens covered by Medicare and Medicaid. That means our senior folks covered by Medicare and Medi-cal. We were told about this potential issue in 2009, remember. 

Will doctors change due to PCORI?

  • Some who belong to large practice groups might if directed to by their group.
  • If payments for services rendered are reduced as a result of  procedures deemed ineffective by PCORI then doctors may change. 
  • Unless there are consequences, either financial or legal, doctors may not modify their current practices simply because of a result of a PCORI award.

My initial opinion was that PCORI was another example of over-reach by the government adding cost to premiums as well as costing taxpayer billions of wasted dollars and unneeded oversight. After doing my research and preparing for this Post, I have found no reason to modify my initial opinion.
Hey, maybe my opinion is just like the results of the billions spent on PCORI; nothing changes!

One other thought has lingered with me since 2010. The ACA also mandated that all health plans submit their data to the CMS and PCORI for the purpose of analysis. By data I mean every individual’s personal & private information including SS#s, employment & health status, and specific information on every healthcare service incurred.

So, how has that data been protected and by whom? The list of entities that have had data breaches is endless and includes cities, states, nations, government agencies, many insurance carriers, and thousands of other private businesses.
Here is a short list with the estimate of records stolen :

  • US Office of Personnel & Management -22 Million
  • Yahoo 1st time -500 Million
  • Yahoo 2nd time -1 Billion
  • Equifax – 143 Million (this is recent and huge!)
  • E-bay -145 Million
  • Anthem -80 Million
  • Target -40 Million
  • Home Depot -56 Million
  •  Sony – 77 Million
  • What are the odds that your personal info was not part of at least one of these?
  • Do you think the health records of our citizens stored at CMS are an attractive target to hackers?

As I said, it was a lingering thought!

Well, you can give it some thought and ask yourself some questions. Have you read or heard anything about PCORI in the past 2 years. Probably not because one of the operative guidelines of PCORI is to be invisible and not draw attention.

Geez, does that makes sense; a government bureaucracy created to analyze comparative treatment outcomes but do so without making any news?

That’s it for now. Let me know what you think or if you’ve seen any data that shines a positive light on PCORI. I want to be fair in our review.

Next week we’ll look at the Graham-Cassidy Healthcare reform bill now being urgently pushed by the GOP. The Senate has until Sept 30th to get it started with only 51 votes.

Until next week, let’s work together and stay positive.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

 

 
 

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