Posted by: Peggy Salvatore
Fear mongering is usually the fodder of the political campaign season. Not this year. The US is so politically divided that the campaigning (read: fear-mongering) doesn’t stop as both political camps stake out their territory on all the issues – carbon cap-and-trade, bank bailouts, car company bailouts and, of course, the ever-popular nationalization of healthcare.
The bogeyman of opponents of nationalized healthcare is the specter of rationing. Just like all very complex and expensive issues, healthcare rationing is not easy to explain or execute. Making rationing work requires a well-funded item in the Congressional budget called Comparative Effectiveness Research, known as CER. Valid CER is not possible without another acronym, EHR. We need fully implemented and interoperable electronic health records to get good CER. I’ll tell you why.
Comparative Effectiveness Research really just means that we know which treatments, therapies and procedures work best for whom and at what cost. Then we decide how much to pay for them based on that knowledge. To get the answer to the question what works best for whom and at what cost, we need to have the results of everyone’s experience.
- I mean everyone, not just a select population - fully documented over time.
- I mean a lot of time and what it costs – I mean really costs taking into consideration all that time.
Then people can make supportable decisions about choosing the very best treatment, therapy or procedure the first time for the correct patients.
To get truly valid data about what works, we have to collect everyone’s experience with every encounter with every provider, organization, product, and service over about a generation.
What we do with that information might be called rationing to fear mongers. It might be called verifiable best practices to others, resulting in cost-effective and efficient, quality care.
Rationing has to do with letting the payer decide whether to pay for the best practices we learn from the information we get from EHR. The payer, not the patient, decides what to do with the information we learn from CER. In that light, perhaps the idea of a one-payer system, especially if that system is the government, needs a closer look.
[Blogger’s note: Most researchers and statisticians will tell you that my conditions for valid CER – everybody, all experiences, over lots of time – are rubbish. To understand my position, I refer you to one of my favorite expressions that I sent my three children off to college with: There are lies, damned lies, and statistics. Question everything, then cut the cards, or something like that. Give me lots of good data, over lots of time, involving lots of people, and I’ll give you lots of good information.]
Peggy Salvatore has been developing managed care and healthcare reimbursement web-based training programs for the healthcare industry for 10 years. She also writes eLearning programs on general business topics such as time management, project management and leadership. Prior to that, her background includes extensive research, analysis and writing for professional journal articles, white papers and executive background briefings on a broad range of health policy issues. She was a political reporter and columnist and covered the 1988 Republican National Convention before leaving daily journalism for the business world. She holds an MBA with a concentration in strategy and economics.