Obamacare research institute plans to spend $3.5 billion, but critics question its worth
On the 9th floor of a glassy high rise in downtown Washington, partitions are coming down to make more room for workers handing out billions of dollars in Obamacare-funded research awards.
Business has been brisk at the Patient-Centered Outcomes Research Institute or, PCORI, as it is known. The institute was created by Congress under the Affordable Care Act to figure out what medical treatments work best — measures largely AWOL from the nation’s health care delivery system.
Since 2012, PCORI has committed just over $1 billion to 591 “comparative effectiveness” contracts to find some answers, with much more spending to come. Money has thus far gone to researchers and medical schools, advocacy groups and even the insurance industry’s lobbying group, which snagged $500,000.
Institute officials say they are reshaping medical research by stressing “patient centered” projects that offer practical guidance to people living with chronic diseases. They cite a $14 million study to settle the debate over how much aspirin people should take daily to help ward off heart disease, or the $30 million project to reduce serious, even deadly, injuries from falls in the elderly.
But like all matters rooted in Obamacare, there are sharp disagreements — both political and scientific — over the core mission of the independent institute. PCORI expects to spend $3.5 billion by the end of the decade. Then it expires.
On both the right and the left, there’s simmering doubt about whether the unusual nonprofit can live up to expectations, or even what those expectations should reasonably be. Others argue these sorts of decisions should have been made prior to committing up to $3.5 billion.
“PCORI seems to have become almost invisible. Maybe they think that's the best way to stay under the political radar screen,” said Gail Wilensky, a former Medicare chief under President George H.W. Bush. The institute has yet to “offer much value,” she said.
Some Republicans are viscerally hostile. They want to kill off, or at the very least, hamstring the institute, fearing it will lead to rationing of medical care by interfering with medical decision-making. The House Appropriations Committee in late June voted to cut PCORI’s funding by $100 million — dubbing it wasteful spending. Earlier this year in the Senate, Kansas Republican Pat Roberts filed a bill to prevent Medicare from using PCORI results to “deny or delay coverage of an item or service.”
“Americans do not want the federal government limiting their treatment options and deciding what is best for them,” Roberts said at the time.
Liberals aren’t singularly thrilled, either. They fault the institute for not evaluating enough drugs and medical devices head-to-head to see which offer the best results — and thus the biggest bang for the health-care buck.
“If it doesn’t prove its worth soon there will be increasing calls for getting rid of it, or reducing its funding,” said Topher Spiro, vice president for health policy at the Center for American Progress, a liberal think tank. “That concerns us.”
PCORI executive director Joe V. Selby, a family physician and researcher, accepts some of the flak. But he argues that Congress directed the institute to explore research topics patients want and need — not to issue edicts on which treatments offer the best bargain.
Related: If it doesn't prove its worth soon...
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Copyright 2015 The Center for Public Integrity. This story was published by The Center for Public Integrity, a nonprofit, nonpartisan investigative news organization in Washington, D.C.
