One of the lesser-known offspring of the Patient Protection and Affordable Care Act has come under fire for its "sluggish" performance in measuring the effectiveness of health care treatments.
The Patient-Centered Outcomes Research Institute was created by the health care reform law to gauge the effectiveness and appropriateness of health care treatments. It's doing so through what's called comparative effectiveness research, which helps researchers determine whether, for example, spinal fusion surgery works better than the alternatives in relieving back pain, or whether proton beam therapy is worth the extra cost to treat prostate cancer.
These are questions that private industry and federal agencies have largely steered clear of. Even the federal Food and Drug Administration, although it judges whether treatments are safe and effective, has avoided comparing whether treatment A is more effective than treatment B.
PCORI was designed to begin to study the question.
But critics have now surfaced, questioning its pace and focus.
Perhaps most notably, Peter Orszag, a vice chairman at Citigroup Inc. and the former director of the Office of Management and Budget in the Obama administration, wrote a Jan. 28 Op/Ed for Bloomberg News Service that said PCORI should be doing more.
"It is simply not possible to make health care more efficient without knowing how treatments stack up against one another," Orszag wrote. "Apparently, though, [PCORI] is falling down on the job."
Orszag based his critique at least in part on a report by the Center for American Progress that found PCORI has dedicated less than 40 percent of its research funding to comparative studies.
The CAP report further faults the organization for not giving priority to areas suggested by the Institutes of Medicine. Out of the 284 studies the institute has funded to date, only 34 (or 12 percent) address these priority topics, CAP said.
Its study also suggests that PCORI has spent too much time on general topics such as "improving health care systems," and "addressing disparities," and not enough on more specific, treatment-focused studies.
It calls on PCORI to use its position as an independent group to confront powerful industry stakeholders that may profit from expensive new treatments that may be no better than less-expensive options.
"To be truly transformative, the institute must finance a bold research agenda and not play it safe," the CAP report said.
Orszag and CAP also question the emphasis PCORI has given to identifying and developing communication strategies for spreading CER findings.
For its part, PCORI has released a statement disputing CAP's assessment of its funding priorities. Instead of devoting 40 percent of its funding to CER studies, as CAP claims, PCORI's executive director, Dr. Joe Selby, said his group has actually devoted 62 percent of its research funds to CER since its founding in 2010.
