Data will drive health care quality

Physicians cannot know if they are providing the most effective treatment for patients unless they have data that supports their clinical choices, said Peter Orszag, director of the Office of Management and Budget.

In detailing some of the Obama administration’s approaches to health care reform, Orszag said patient-centered research and information technology that will deliver research data to doctors are two long-term game changers the administration believes will help transform the health care system.

Providers sometimes do not have evidence on hand to help them determine the most effective treatment or tests. “We need much more information tied to medical systems so that doctors and hospitals know what works and whether additional procedures are warranted,” Orszag said today at a conference sponsored by the Brookings Institution.

Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, also weighed in, saying that such data would help health care consumers as well. “When Americans go shopping, they do research on what works and what doesn’t,” he said. “You can’t go shopping like that for health care.”

Baucus plans to re-introduce legislation later this month that calls for research into the comparative effectiveness of treatments as part of comprehensive health reform efforts.

Orszag said physicians are often hampered by lack of access to historical data on whether some treatments work better than others under similar conditions.

“Too much of the health care delivered in the United States is not backed by any evidence that it works better than an alternative,” he said. “In fact, the largest variation seems to occur, as evidence suggests, in precisely those places where we don’t know what works and what doesn’t.

“Where it’s clear what should happen, the variation is less extreme,” Orszag said. “Where there is a lot of ambiguity, there is more variation. And we have a payment system that rewards the more intensive approaches not backed by evidence that they work.”

For example, he said, only about half of the clinical practice guidelines from the American College of Cardiology and the American Hospital Association are backed by hard evidence that the procedures are justified. And the Institute of Medicine has suggested that as much as half of the health care delivered in the United States is not backed by specific evidence that it works, Orszag said.

He cited an article by Atul Gawande in the June 1 issue of The New Yorker describing how the Centers for Medicare and Medicaid Services spent almost twice as much as the national average on enrollees in McAllen, Texas, compared with those in El Paso, which had similar demographics and where costs more closely mirrored the national average. The higher costs in McAllen did not translate to higher-quality care.

Financial incentives should reward providers for quality, not volume, Orszag said. “Our system actually penalizes providers who are more efficient,” he added.

Many of the physicians in the Texas study said they were unaware that they were greater users of the health care system or were ordering more tests and procedures than their peers. “Simply providing information and benchmarking against comparison cities or comparison hospitals and comparison doctors can help address regional variations and move toward a quality-oriented system,” Orszag said.

Dr. Sean Tunis, founder and director of the Center for Medical Technology Policy, said there must be more investment in the technical infrastructure for sharing effectiveness research. Some of his recommendations at the conference and in an accompanying paper include:

Making sure that data standards for electronic medical records support practice-based clinical research.

Developing informatics grids and other architectures to link practice-based research networks.

Supporting distributed data networks for administrative and clinical databases with safeguards for the privacy and security of protected information.