Going after the $20 billion for health information technology (IT), $1 billion for comparative effectiveness research, $10 billion for NIH clinical research, and $2 – $3 billion for prevention activities in the stimulus bill (ARRA) will be a big-time goal for many organizations. It’s time to get in there and grab some dough. The competition for dollars will be fierce, but we have some very sound ideas about how to spend stimulus funds for quality health care. There is an opportunity for registries to be piloted for quality improvement activities. There is still no reimbursement “business case” proposed, but that too could be piloted. Our academic colleagues need to get ready to go after the NIH dollars as well.

The comparative effectiveness research (CER) piece is probably the most controversial. Frankly we would need $1 B annually for 20 years to really get serious about having the massive amounts of additional evidence we need for turbocharging guidelines, performance measures and appropriate use criteria.

Separating cost effectiveness from clinical effectiveness is key to de-politicizing the CER process. Cost effectiveness is critical, but it needs to be done once an objective clinical effectiveness process is completed around any topic. The ACC strongly supports clinical CER. But, one of the risks here -- as shared this week by Avalere Health is that some observers see CER as a way for the federal government to take complete control over guidelines, performance measures and appropriate use criteria. AHRQ shares openly how they did not succeed well in this, when they did try engaging in guideline development a few years back. It costs them too much to produce what we can do with mostly volunteer FACC and researcher efforts; and they got hung up in dangerous political issues in the Congress when various elements of industry didn’t like their results. Better to have a federal agency like NQF or AHRQ look over the shoulders of the profession to vet our guideline efforts, which are bound to be more trustworthy to physicians, and therefore more widely adopted.

Stay tuned, and be certain ACC will be centrally involved in pushing for the best, most objective, and patient centered evidence. We need more of it -- and it’s a important part of the profession’s accountability -- to lead in making that happen! Importantly, we need to clarify to the confused that guidelines are not rigid cookbooks -- see the post last week from ACC past president Jim Dove.

*** Obama signs ARRA into law. Image from Wikimedia Commons (Pete Souza) ***

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