Samuel Lin, American Medical Group Association
On April 3, 2009, public testimony on comparative effectiveness
research was given at a meeting of the National Advisory Council
for Healthcare Research and Quality. The testimony represents
the views of the presenter and not necessarily those of the Agency
for Healthcare Research and Quality (AHRQ) or the Department
of Health and Human Services (HHS).
The Council provides advice and recommendations to the Director,
AHRQ, and to the Secretary, HHS, on priorities for a national
health services research agenda.
SAMUEL LIN, MD, PhD, MBA, MPA, MS
AMERICAN MEDICAL GROUP ASSOCIATION
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
NATIONAL ADVISORY COUNCIL MEETING
COMPARATIVE EFFECTIVENESS RESEARCH
April 3, 2009
I am Sam Lin, a Family Physician, representing the American
Medical Group Association based in Alexandria, Virginia. AMGA is
a professional medical association representing some of this
nation's largest, best known, and prestigious integrated
health care delivery systems. More than 95,000 physicians practice
in AMGA member organizations and provide health care
services for approximately 95 million patients.
Today, in the context of the Comparative Effectiveness Program
to be funded by AHRQ, you are hearing comments with a focus on
several disease conditions and treatments. And while critical
to the discussion, it is imperative that we also examine the
context for this care. Unless the delivery system is considered,
we otherwise would continue to promote fragmented care, leaving
patients to wander on their own. AMGA supports the fundamental
concepts of comparative effectiveness information use in health
care delivery, but we also believe that delivery systems matter.
There is an emerging body of evidence that supports this idea,
and it is also being tested in several CMS demonstration projects.
We strongly recommend that this Advisory Council consider comparative
effectiveness in its broadest terms, not limited to research
on treatments and devices alone.
CER should be undertaken for quality, effectiveness, and other
appropriate dimensions for health care delivery systems along
the entire spectrum of systems integration. This spectrum should
include integrated delivery systems, multi-specialty group practices,
single-specialty groups, "virtual" groups such as
IPAs, PHOs, and small medical practices (solo, duo, small groups),
and perhaps others.
Use of comparative effectiveness information on delivery systems
would facilitate and strengthen provision of patient care, disease
states, and related financial determinations. By knowing what
works best in treating patients, the nation's healthcare
delivery system could make substantial strides toward improving
clinical outcomes, closing gaps in geographic variations, while
reducing health care expenditures. While we favor CER, we temper
that view with caution that such information must be objective,
developed by disinterested parties, and should be equally applied.
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