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Evidence Based Analysis essay assignment
Need 3 (not including title and reference pages) page paper addressing the information below.
Paper must be in APA style and have at least 3 scholarly resources
- Explain the process of evidence-based analysis.
- Highlight the major players and their roles in EBM policy (i.e., government, providers, patients, etc.).
- Explain the EBM “Levels of Evidence” as defined in your course text.
- Review the case “Constraints of the ACA on Evidence-Based Medicine.”
- Provide a written analysis of the case “Constraints of the ACA on Evidence-Based Medicine” in Chapter 9 of your textbook. (Utilize the “Levels of Evidence and Grades of Recommendations” as defined by the National Guideline) Clearinghouse. (See below)
- Summarize the policy of EBM in your conclusion.
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Case Analyses
cine in the 2009 stimulus act and established the Patient-Centered Out- comes Research Institute (PCORI) within the Centers for Medicare & Medicaid Services. However, the same legislation limited the ways the Institute’s research could be used within the Department of Health and Human Services. There clearly was a concern among federal lawmakers that these research findings would find their way directly into the workings of the even more controversial Medicare Advisory Payment Commission.
Pearson and Bach (2010) noted:
Under current law and because of years of precedent, Medicare generally covers any treatment that is deemed “reasonable and necessary,” regardless of the evidence on the treatment’s comparative effectiveness or its cost in relation to other treatments. Like- wise, with only rare exceptions, Medicare does not use comparative effectiveness information to set payment rates. Instead it links reimbursement in one way or another to the underlying cost of providing services. (p. 1796).
This is quite different from the way comparative effectiveness research is used in other counties at various regulatory stages, such as new drug approvals and approved protocols. Congress maintained this status quo, in part, by placing a number of constraints on the use of comparative effectiveness research. Section 6301 amended Section 1181 of the Social Security Act to establish the Institute with the following purpose:
The Institute is to assist patients, clinicians, purchasers, and policy- makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis that con- siders variations in patient subpopulations, and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services, and items described in subsection (a)(2)(B).
ADDING CONSTRAINTS
However, the ACA went on to specify: SEC. 1182 o42 U.S.C. 1320e–1. (a) The Secretary may only use evidence and findings from research conducted under section 1181 to make a determination regarding coverage under title XVIII (Medicare) if such use is through an iterative and transparent process which includes public comment and considers the effect on subpopulations. (b) Nothing in section 1181 shall be construed as— (1) superceding or modifying the coverage of items or services under title XVIII that the Secretary determines are reasonable and necessary under section 1862(l)(1); or (2) authorizing the Secretary to deny coverage of items or services under such title solely on the basis of comparative clinical effectiveness research. (c)(1) The Secretary shall not use evidence or findings from comparative clinical effectiveness research conducted under section 1181 in determining coverage, reimbursement, or incentive pro- grams under title XVIII in a manner that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, nondisabled, or not terminally ill. (2) Paragraph (1) shall not be construed as preventing the Secretary from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive programs under title XVIII based upon a comparison of the difference in the effectiveness of alternative treatments in extending an individual’s life due to the individual’s age.
The law further restricted use of the findings in other sections:
(d)(1) The Secretary shall not use evidence or findings from comparative clinical effectiveness research conducted under section 1181 in determining coverage, reimbursement, or incentive pro- grams under title XVIII in a manner that precludes, or with the intent to discourage, an individual from choosing a health care treatment based on how the individual values the tradeoff between extending the length of their life and the risk of disability. (2)(A) Paragraph (1) shall not be construed to— (i) limit the application of differential copayments under title XVIII based on factors such as cost or type of service; or (ii) prevent the Secretary from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive programs under such title based upon a comparison of the difference in the effectiveness of alternative health care treatments in extending an individual’s life due to that individual’s age, disability, or terminal illness. (3) Nothing in the provisions of, or amendments made by the Patient Protection and Affordable Care Act, shall be construed to limit comparative clinical effectiveness research or any other research, evaluation, or dissemination of information concerning the likelihood that a health care treatment will result in disability. (e) The Patient-Centered Outcomes Research Institute established under section 1181(b)(1) shall not develop or employ a dollars-per- quality adjusted life year (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost effective or recommended. The Secretary shall not utilize such an adjusted life year (or such a similar measure) as a threshold to determine coverage, reimbursement, or incentive programs under title XVIII. Additional constraints in the law included:
- Section 6301 (d)(8)(iv), which states: “The Institute shall ensure that the research findings . . . do not include practice guidelines, coverage recommendations, payment, or policy recommendations.”
- Section 6301(j), which addresses the rule of construction, includes this language concerning coverage: “Nothing in this section shall be construed . . . to permit the Institute to mandate coverage, reimbursement, or other policies for any public or private payer.”
- Section 6301 adds a Section 937 on Dissemination and Building Capacity for Research to Title IX of the Public Health Service Act, which states: “Materials, forums, and media used to disseminate the findings, informational tools, and resource databases shall . . . not be construed as mandates, guidelines, or recommendations for payment, coverage, or treatment
