There are provisions in the new Stimulus Bill to create a Government Oversight Board for ensuring that there is nationwide compliance with comparative clinical effectiveness, namely rating and ranking procedures, medications and the like for the treatment of various medical ailments.
Let us consider the colonoscopy. There already exists a "Centers for Medicare and Medicaid services" the "CMS" which has been performing that task for Medicare and Medicaid for years. Their most recent prognostication was that CT virtual colonoscopy had not met the level for acceptance so that it would not receive payment as an accepted procedure. This may very well be a valid conclusion. The reasons themselves may be varied and the procedure may still be performed unless the new Board as passed under this new Bill agrees with the CMS and then eliminates it.
But let us take another further look. A group of Canadian physicians performed a study that reached the conclusion as follows:
"Conclusion: In usual practice, colonoscopy is associated with fewer deaths from CRC. This association is primarily limited to deaths from cancer developing in the left side of the colon."
Namely they contend that based upon their study there is no benefit to screening for ascending colon lesions. The devil is in the details,however. First the Canadian system admits patients to colonoscopies at very late stages, it is truly a rationed system and in preventative medicing rationing means getting there too late.
Second, these are Canadian physicians in Canadian medicine which means that they permit less than fully qualified practioners to perform these tests which require true skill and care. Their results included the following Table demonstrate that almost anyone can perform this procedure which demands great experience. The procedures were performed by a mix of physicians, most, if not all, not certified as endoscopists.
As is well known, colonoscopies can nearly eliminate colon cancer if performed by a skilled endoscopist. Sessile lesions in the folds of the colon are generally the greatest threat. They get missed and they are the killer lesions. Thus the endoscopist must be skilled, must take care and time, and must be thorough. The result is that a procedure costing some $1,200-1,800 can save not only a life but hundreds of thousands in subsequent medical costs.
So how does the new Stimulus Bill, the existing CMS and the Canadian study all blend together? Simply, first we have a functioning Comparative Effectiveness system in place, it functions and already controls over 50% of healthcare. Thus Medicare and Medicaid will see no change, unless, and that is the big question, unless it is done for other purposes than patient care. However it is now possible that all other patients will see an impact, NO! will most likely become a common refrain.
Secondly, studies like the less than useful Canadian Study may become the hook to hang reduction of procedures on, especially as we see the new Board has a mix of Physicians and non-Physicians. Imagine Nancy Pelosi look-alikes on such a Board. There are even worse imaginantions!
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