Wednesday, July 4, 2012

Something to Watch

PCORI is an off-shoot of the ACA. It states its mission as:

The Patient-Centered Outcomes Research Institute (PCORI) is authorized by Congress to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. PCORI’s research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options.
The Patient-Centered Outcomes Research Institute (PCORI) helps people make informed health care decisions, and improves health care delivery and outcomes, by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader health care community.
Patients and the public have the information they need to make decisions that reflect their desired health outcomes.

Now this is one of the hundreds of Federal Government Agencies, off book if you will, which have no reporting requirement to Congress, which will mandate what health care we get. Yes, in my opinion, this is where the morbidly obese GS9s will find homes and deny folks care. You can lay bets on this one.

How is it funded:

PCORI is funded through the Patient-Centered Outcomes Research Trust Fund (PCORTF), which was authorized by Congress as part of the Patient Protection and Affordable Care Act of 2010 and receives income from two funding streams:  the general fund of the Treasury and a small fee assessed on Medicare, private health insurance and self-insured plans. PCORI is expected to receive an estimated $3.5 billion from the PCORTF to fund patient-centered outcomes research through September 30, 2019, the date through which the Act authorizes it to remain in operation.

Yes folks it is funded by us old folks with increased Medicare costs at in my opinion less coverage.
Its budget is as follows:

For FY 2010, $10 million
For FY 2011, $50 million
For FY 2012, $150 million
For FY 2013, the PCORTF will receive $150 million from the general fund in appropriation plus an annual $1 fee per individual assessed on Medicare and private health insurance and self-insured plans. The combined estimated total is $320 million.

For FYs 2014-2019, the PCORTF will receive $150 million from the general fund in appropriation plus an annual $2 fee per individual assessed on Medicare and private health insurance and self-insured plans and an adjustment for increase in healthcare spending. The combined estimated total averages $650 million per year.

 This will be an exploding costs base. The Government, rather than physicians and patients, will be telling us what is good for us, as I read the details. That is $650,000,000 per year as a starter for studies, yes studies. Not clinical studies, but Government funded, which in my experience means that someone has a conclusion and they seek some Beltway Bandit to confirm their view.

In Massachusetts alone the following have apparently been funded:

  1. Influence & Evidence: Understanding Consumer Choices in Preventive Care
  2. Developing and Testing a Decision Support Tool for Primary Medication Adherence
  3. Direct Engagement of Stakeholders in Translating CER into Clinical Guidelines
  4. Incorporating Parent Preferences in Decision Making about Childhood Vaccines
  5. Assessing and Reporting Heterogeneity of Treatment Effect in Clinical Trials
  6. Developing an Analytic Tool to Assess Patient Responses
  7. Patient Experience Recommender System for Persuasive Communication Tailoring
  8. Decision Support for Symptom and Quality of Life Management
 These are all somewhat questionable in my opinion. Take the CER conversion into clinical guidelines. Take specifically the elimination of PSA tests by the Task Force as an example. This means that the actual lives saved will no longer be considered. The Government is writing the medical books. It does not even have a license to practice but it it now controlling how we are treated. One must and should be concerned as to what use these "studies" will be put. This will also most likely change "peer review" so that in my opinion the Government "peer review" specialists will mandate what is truth. McLuhan would have had a field day with this construct.

This is truly worth watching. They have Pilot Projects shown and this may provide some insight. But one must keep in mind that this is just one of the hundreds set up under the ACA! Watch the Deficit explode! And the care implodes! Happy 4th.