DJP Update 2-28-2012 PCORI testimony; my new leadership book; visit to Library of Congress; LAGNIAPPE: MARDI GRAS
Dateline Washington, DC
Enroute home – in flight at 30,000 ft.
ITEM ONE: PCORI Testimony
PCORI (Patient-Centered Outcomes Research Institute) was brought into existence by the healthcare law, PPACA. The purpose of PCORI is to do comparative effectiveness research (CER).
I gave testimony on PCORI yesterday at the PCORI hearing held at the National Press Club yesterday. An all-day event with perhaps 75 witnesses, 75% in the room and the other 25% connected by phone. There also were panel discussions. Dr. Ardis Hoven, AMA immediate-past chair, was on one of the panels.
My testimony was on behalf of The Coalition to Protect Patients and two former AMA presidents, Dr. Bill Plested and myself. Everyone had 3 minutes of oral testimony and additional written testimony was submitted. Well organized event. Others sent in views by email, including Dr. Marcy Zwelling. There is still time to submit your views and recommendations at www.pcori.org
Terrific testimony by Dr. Carter Beck, neurosurgeon in Montana, who attended event and gave oral testimony.
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The longer written testimony from Dr. Plested and me and the Coalition can be read at: http://protectpatientsrights.org/the-news/259-letter-from-former-presidents-of-the-american-medical-association-to-pcori-executive-directot-joseph-selby
In both the oral testimony and the written testimony, this was stressed (two excerpts):
“As former presidents of the American Medical Association, we are here to tell you that doctors need your support. As a medical profession, we are under unprecedented pressure from an array of sources. One of these pressures is a growing array of increasingly intrusive government standards and mandates. Another one is attempting to use the best available evidence to make the optimal treatment decisions with each one of our patients in the face of increasingly aggressive coverage restrictions and utilization management tools. We, as physicians, cannot practice evidence-based medicine when we have a growing array of cost-based restrictions. The question we pose to the Patient-Centered Outcomes Research Institute is whether you will build an agenda that adds to this pressure, or gives doctors support in the face of it. Our plea is that the answer would be the latter.”
“We understand that any number of rationales can be devised for including cost in your agenda. However, while we trust this is not your intent, doing so gives the impression of a board of experts that is setting itself above the law because it “knows better.” Most American physicians are aware that governments can use CER results as excuses to ration medical care. In Great Britain, the National Institute of Health and Clinical Excellence (NICE)—a board which is eerily similar to PCORI—conducts research and then recommends to the National Health Service what it should and should not cover in accordance with those results after applying Quality-adjusted life-years (QALYs) with cost as numerator and actuarially determined quality years of life left as the denominator. (note: in the oral testimony, I pointed out that if the answer of the division is a money amount greater than some bureaucrat picked, the treatment is not approved.)
“We ask PCORI to revise its priorities and agenda to focus on better patient care by focusing on clinical and patient health outcomes. The consideration of cost is going to be problematic for many if not most Physicians. Medical ethics guide Physicians to carefully review all options with pros and cons with their patients and to recommend the treatment that presents the best results for that individual. Problems will arise only if only one alternative based upon cost is all that the physician is allowed to offer to the patient. Sooner or later patients will learn that alternatives with a better promise of cure were withheld and this will destroy the trust that is the foundation of the patient-physician relationship.”
“The consideration of cost is going to be problematic for many if not most Physicians. Medical ethics guide Physicians to carefully review all options with pros and cons with their patients and to recommend the treatment that presents the best results for that individual. Problems will arise only if only one alternative based upon cost is all that the physician is allowed to offer to the patient. Sooner or later patients will learn that alternatives with a better promise of cure were withheld and this will destroy the trust that is the foundation of the patient-physician relationship.”
I was quoted after the event in POLITICO PRO:
Excerpt:
PCORI told to keep the focus on patients’ needs
By Kate Nocera
2/27/12 6:18 PM EST
Listen to the patients. (start of article)
(near end of article is my quote)
But former American Medical Association president Donald Palmisano, who is now the spokesman for a group opposed to the health care law, sternly warned PCORI needed to keep the doctor’s needs in mind as well as the patients.
“We are under unprecedented pressure from increased government standards and mandates,” he said. “We as physicians cannot practice evidence-based medicine when we have a growing array of cost based restrictions. … We believe the patient ought to be the decision-maker along with the doctor as the trusted adviser.”
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I also wrote an Op-Ed about PCORI that was accepted by the Washington Times and is scheduled to be published this week.
ITEM TWO: my new book on leadership & library visits
My new book on leadership will be out in October. Had a great meeting in New York City with my publisher. I now have research privileges at New York Library, (J.P) Morgan Library, Library of Congress, and the Jefferson Parish Public Library (where my sister is a librarian!) Got my photo ID & approval today in Library of Congress. Staff extremely helpful. I love visiting libraries.
I am looking for suggestions from everyone on this email list. My request is to send me your recommendation of a woman leader or leaders, past or present, and the reasons why. Thanks! (Goal: for consideration of use in my new book on leadership.)
LAGNIAPPE: Visit www.twitter.com/DJPNEWS for latest tweets & see Mardi Gras photos at: http://twitpic.com/photos/DJPNEWS
Had two guests in town for their first Mardi Gras. Great fun! Also, a photo of the PCORI hearing is at that site.
Stay well.
Donald
Some past selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/
Donald J. Palmisano, MD, JD
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