Government should not interfere with patient-physician decision making

During the 2009 discussions and debates over the Affordable Care Act (ACA), I served as the chair of the House GOP Doctors Caucus, leveraging my more than 25 years as a practicing OB-GYN, and one key issue of significant concern for our group was the promotion and utilization of cost-effectiveness data and comparative effectiveness research (CER).

We were concerned that such information would be used to support government takeover of the practice of medicine, and specifically that these types of analyses and studies would dictate decision-making to doctors.

{mosads}Last week, I had the pleasure of speaking at the 3rd Annual Meeting of the Patient-Centered Outcomes Research Institute (PCORI), an independent, non-profit research agency authorized under the ACA to conduct comparative effectiveness research (CER). Before taking the stage in front of nearly 1,000 patients, family caregivers, researchers, clinicians, and other healthcare stakeholders, I reviewed a large portion of PCORI’s research portfolio.

In each disease and health condition domain I examined, the PCORI-funded CER identified risks that doctors and patients should discuss when making treatment decisions. For example, concerning the 3 million American men with a diagnosis of prostate cancer, PCORI found that surgery and radiation treatments both carry elevated risks of side effects over the simple strategy of watchful surveillance. This study doesn’t tell doctors or patients which treatment is best but provides impartial information to inform individualized clinical decision-making, far from the “cook-book” medicine we feared.

We were concerned that CER would morph into a mechanism to ration care — perhaps through a rationing body like the UK’s National Institute for Health Care and Excellence — and this, the House Doctors Caucus felt would be contrary to the American way of health care.

Appreciating this concern, Former rep. Sen. Kent Conrad (D-N.D.) played an instrumental role in the final version of the CER and PCORI related provisions in the enacted ACA; he deftly crafted a compromise to ensure that the findings would be available to inform clinical decision-making and could not be used for government insurance coverage and payment policies.

More than seven years later, with an impressive body of research, PCORI is advancing knowledge and disseminating that information to the benefit of patients, physicians and the health care system. This work is being done with input from all health care stakeholders and importantly, the results are not being put forth in an autocratic manner.

In 2009 I felt strongly — as I still do today — that the government should not interfere with patient-physician decision making and should not have policies that prioritize cost reductions over effectiveness or promote savings over patient preference and physician experience. Benjamin Franklin said that “an investment in knowledge pays the best interest.”

As we deepen and improve our approach to both federally funded and privately supported CER, we will undoubtedly learn more about how different treatments and interventions affect different patients and different populations.

The inclusive approach PCORI takes advances knowledge, fills gaps, and helps ensure that we do not duplicate efforts both within the federal government and more broadly.

In conversations I had with attendees at PCORI’s Annual Meeting, a number of them — from a range of stakeholder groups – asked me about the fact that PCORI’s funding authorization expires in 2019.

Although I was once a skeptic I will be supporting its reauthorization, calling for it to continue to receive federal funding. I encourage my colleagues in both parties and both sides of the Capital, to lend their support as the PCORI studies certainly are helping Americans extend and improve the quality of our lives. And that is a prescription I certainly would write.

Philip Gingrey, MD is a former U.S. Congressman having served Georgia’s 11th congressional district from 2003 to 2015. He is currently a senior adviser with the District Policy Group at Drinker Biddle & Reath LLP.