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Treating Poor Treatment

Far too much of the care delivered today in American hospitals, clinics, outpatient centers and other settings is not based on solid medical evidence. Estimates are that as much as 30 percent of the overall care delivered in our country is ineffective, inappropriate or redundant, according to research by John E. Wennberg, MD, director of …

Far too much of the care delivered today in American hospitals, clinics, outpatient centers and other settings is not based on solid medical evidence. Estimates are that as much as 30 percent of the overall care delivered in our country is ineffective, inappropriate or redundant, according to research by John E. Wennberg, MD, director of the Center for Evaluative Clinical Sciences at Dartmouth University.

We must help physicians, nurses and other health-care professionals deliver better, safer and more consistent care to their patients. This also will help us make more effective use of our nation’s limited health care expenditures-already topping $2 trillion annually, or about $7,000 for every man, woman and child in the U.S.

Blue Cross and Blue Shield has called on Congress to pass a bill to create an independent institute devoted exclusively to developing credible clinical information on the comparative effectiveness of new and existing medical procedures, drugs, devices and biologics. The new institute is the centerpiece of our Pathway to Covering America, a comprehensive five-point Blue Cross and Blue Shield plan for fundamentally changing health care in our country by building on our employer based system to improve quality, rein in costs and expand coverage to the millions of our citizens who don’t have health insurance today.

The new institute should be developed based on several core principles.

First, it should be an independent entity, nonprofit, and governed by a board of experts representing diverse interests, including public and private payers, providers, consumers and other key industry stakeholders. It should be protected from outside pressures-including political interests-so it can truly be a credible source for evidence based information.

Second, it should support a broad range of research to evaluate the clinical effectiveness of different procedures, drugs, devices and biologics. This would include clinical trials, which can cost millions of dollars.

Third, the institute should focus on collaboration. Under our current system, medical research takes up to 17 years to be incorporated into healthcare practice. The institute should work collaboratively with clinicians and medical societies, and it must maximize available research dollars by widely encouraging collaboration and efficiencies across all institutions. This includes disseminating reports and new comparative information promptly and widely to providers and all other stakeholders in easy-to-use formats.

Moreover, e-prescribing and electronic health records-which can improve quality and save lives-should be required to incorporate agreed-upon guidelines into provider clinical decision support systems.

We also propose a significant change in the malpractice arena. Providers that follow agreed-upon guidelines developed by the institute should be given safe harbor for non-economic and punitive damages.

This could go a long way toward badly needed tort reform and help rid us and our overworked court system of often-frivolous lawsuits that benefit trial lawyers far more than their consumer clients.

As Congress and the presidential candidates refine their health care positions, the time is right to create an independent institute to assure the best and most effective medical treatments for our citizens. We in the Blues stand ready to work with Congress and our next president to make the institute a reality to improve the quality and value of our health care system, while expanding access to all.


Scott P. Serota is president and CEO of Blue Cross and Blue Shield Association.

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