MINNEAPOLIS, Minnesota — A top Medtronic Inc. reimbursement official warned Wednesday that government efforts to control health care costs through evidence-based medicine could stifle innovation and drain money away from promising technologies.
Speaking at the annual LifeScience Alley conference, Bob Thompson, senior director of reimbursement, economics and health policy for Medtronic’s core Cardiac Rhythm Device Management division, said the company generally supports efforts to evaluate medical treatments by comparing their effectiveness on patients.
But focusing on cost instead of quality amounts to being little more than “a used car salesman,” Thompson said.
Comparative effectiveness research (CER) has emerged as a controversial, if less prominent, component to the debate over health care reform. Proponents say CER will ultimately save money by pushing the government to only pay for treatments that science shows to work. The country’s health system too often opts for the latest, most-expensive treatments instead of the most effective, some experts say.
“Hard evidence is often unavailable about which treatments work best for which patients and whether the added benefits of more-effective but more-expensive services are sufficient to warrant their added costs,” according to a 2007 report by the Congressional Budget Report. “Yet the current health system tends to adopt more-expensive treatments even in the absence of rigorous assessments of their impact.”
But tying reimbursement to CER, which could take years, if not decades, could kill start-ups, Thompson said.
“When does reimbursement in CER begin?” he said. “It could take 10 years. Your venture capital will dry up and go away. … There is a concern that flame of innovation will be snuffed out.”
Opponents also liken CER to “health care rationing,” a politically loaded term akin to “death panels,” in which government bureaucrats decide which patients get what treatments and when.
But CER is needed to fix a system that costs so much but produces so little, said Dr. Kent Bottles, president of the Institute for Clinical Systems Improvement, a non-profit organization in Bloomington that focuses on health care reform.
“The state of clinical effectiveness is not so great today,” Bottles said. “We don’t know a whole lot about what we are doing. We spend so much on health care but we don’t get good results.”
When discussing CER “you really can’t take cost out of the equation,” he said. “I hate to break it to people but we already have rationing. We just do it on an ad hoc basis. It’s really a red herring to talk about rationing. … Do we have the political will to know that everyone is going to die someday? Do we want to throw expensive treatments toward people at the end of their lives?”
Analysts says CER will likely emerge in any health care bill. President Obama’s stimulus program already allocates $1.1 billion to CER, including $400 million to the National Institutes of Health to test whether new medical technologies really represent an improvement on existing therapies.
“CER has got a long way to go,” said Mark Walinske, CEO of Boundary Medical Inc., a software company based in Minnetonka. “We should focus on the first principles, getting evidence around treatments. CER has prompted a number of companies to get started to think about how to find out what about their services and products. It’s a search for facts. Let the best device, doctor and health plan win.”