Sunday, July 22, 2012

Supporting (Opposing) Patient-Centered Outcomes

On July 17, the Republican-controlled House Appropriations Committee posted online the proposed, fiscal year 2013 spending bill for the Departments of Labor, Health and Human Services, Education and related agencies.

This bill would end health care research in the following areas:
  • The bill ends all funding for the Agency for Healthcare Research and Quality (Sec. 227).
  • The bill prohibits any appropriated funds from being used for patient-centered outcomes research (Sec. 217).
  • The bill prohibits funds appropriated for the National Institutions of Health (Title II, page 57, lines 20-24) from being used for any economic research.
The second one is strange, because "patient-centered" is a phrase developed in focus groups by Republican pollster Frank Luntz to describe Republican health care policies. For some examples of Republican comments using the phrase following the Supreme Court's decision on the Affordable Care Act, see David Weigel's blog posting on Slate on July 2.

And I found these other more recent examples on Twitter:
  • Americans for Prosperity: "RT if you reject the government takeover of #healthcare & want real, patient-centered reform!" (7/20/12)
  • George Allen: "I want to be the deciding vote to repeal this health care law & replace it with patient-centered reforms for more affordable health care." (7/16/12)
  • Sarah Palin (via Kim Moons): "Our vision is of an America where health care is affordable, it's patient centered, and it's market driven."
So Republicans are in favor of patient-centered care, but are not interested in spending money for any research into what would be effective patient-centered care?

Even more confusing is that patient-centered care is an important part of the Affordable Care Act that Republicans want to repeal.  The phrase "patient-centered" (or "patient-centeredness") appears 15 times in the ACA, not counting the headings of titles, sections, and subsections, and not counting references to the "Patient-Centered Outcomes Research Institute" or the "Patient-Centered Outcomes Research Trust Fund."

One of the main ways that the ACA is supposed to hold down Medicare costs is through "accountable care organizations" (ACOs) and one of the requirements of an ACO is that it meet patient-centeredness criteria to be established by the Secretary of Health & Human Services.  (Sec. 3022)  And one of the ways that the ACA is supposed to hold down Medicaid costs is through supporting the creation of "patient-centered medical homes."  (Sec. 3502)

But Republicans want to repeal the whole ACA, including its provisions for patient-centered care, in order to enact patient-centered care, and meanwhile are working to block any research into developing models or techniques for patient-centered care.

This is terribly schizophrenic.  There are either conflicts and disagreements within the Republican party, or the whole Republican "patient-centered" talking point is just a smoke screen for repealing the ACA without offering anything in its place.

My vote is the latter.

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