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Wither EBP? The PATIENTS Act of 2009

July 22, 2009
by Terry L. Stawar, Ed.D.
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Senate Republican Leader Mitch McConnell (Ky.) and Senate Republican Whip Jon Kyl (Ariz.) have introduced a new bill entitled “The Preserving Access to Targeted, Individualized, and Effective New Treatments and Services (PATIENTS) Act of 2009” If passed, this legislation would limit the use of comparative effectiveness research by the federal government in denying healthcare treatment, based on cost.

McConnell has said, “Doctors should have as much good information as possible when treating their patients, but the government shouldn’t use this information to deny access to treatment or procedures that patients and doctors choose to pursue.”

New Republic columnist Jonathan Cohn asks whether the Republican senate leadership is willing to extend a similar ban to private insurers, since they factor cost into treatment decisions all the time.

More importantly if the doctor-patient decision is sacrosanct, and together they decide to used a treatment that is shown to be less effective, should the government have to pay for the less effective treatment as well.

Comparative effectiveness research recently got a 1.1 billion dollar boost from the economic stimulus package which has critics up in arms. Besides fears that the government will use this data to ration healthcare based on cost, others are concerned that this type of research will also stifle the search for even better and more effective treatments approaches. Once a treatment modality emerges as a winner, funding and motivation to find an even better approach may be diluted.

Despite parity and the constant call for integrated behavioral health and physical healthcare, behavioral health is on the sidelines in this conversation right now. However, it seem almost certain that Medicaid will eventually only pay for limited list of evidence based behavioral healthcare practices. But what will this legislation, if passed mean for the future of evidence based practices, especially in behavioral healthcare?

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Comments

Doug, I think this proposed bill pits choice vs. empirical evidence. It smacks a little of distrust of the scientific method, while cloaked in consumer choice. There is little doubt, however, that many of us clinicians are often reluctant to introduce new clinical technologies, especially if we have to abandon those approaches in which we are proficient and have learned to trust. Ironically perceived efficacy of a treatment approach seems to be one of the factors in how well a treatment method actually works. Many still want the practice of psychotherapy in particular to be an art, as well as science, and there is still a lots of distrust in what is seen as manualized, cookie-cutter, cookbook treatment modalities regardless of the empirical evidence.

You raise an interesting question, Terry. And then there is also the field's well-known lag time in translating research into practice.

Terry Stawar

President/CEO (LifeSpring, Inc.)

Terry Stawar

@tstawar

planetterry.wordpress.com

Terry L. Stawar, EdD, is President and CEO of LifeSpring Health Systems, a community behavioral...