It is clear from my conversations with members of Congress and their staff that they feel comparative effectiveness is an essential way to eliminate inappropriate uses of technology and save money. The House last year approved an expanded federal comparative effectiveness effort in the CHAMP Act, and similar legislation is expected to be included in a Senate Finance Committee Medicare package as well. However, while they clearly love it as a general concept, the definitions of comparative effectiveness tend to vary depending on who you’re talking to. From the ACC perspective, we plan to drive the issue in a way that ensures this research, along with any conclusions arising from it, is based on valid data, patient-centered evidence and care needs.

The ACC believes that comparative effectiveness research should reflect the principle that physicians and patients should have the best available evidence upon which to make choices in health care items and services. While a potentially valuable tool--if conducted correctly--for improving both the quality and cost of health care, physicians, patients, policymakers and payers must use the research findings wisely once obtained. The potential for misuse and abuse of such research is substantial—and can have significantly negative impacts on access to care for not only our most vulnerable populations, but potentially all stakeholders.

We also firmly believe that keeping cost analyses independent of comparative clinical effectiveness research ensures that the clinical research achieves a high degree of credibility among all stakeholders. Specifically, this is achieved by ensuring that any entity responsible for supervising/conducting this research must not also be--or be part of--an entity that makes coverage and benefit decisions (such decisions should be left to employers, insurance companies, CMS, state Medicaid departments, etc.).

Finally, the concurrent development and implementation of strategies for the widespread dissemination and use of the results of comparative research by health care providers should be accomplished through systematic programs of physician education and support from specialty societies like the ACC (which has its own practice guidelines and other quality improvement tools).