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Coverage with Evidence Development in Medicare

February 26, 2011

There is continuing interest among policy makers in the United States about the use of Coverage with Evidence Development (CED) in the Medicare program,   In 2010, the Medicare Payment Advisory Commission (MedPAC), an influential panel of experts that advise the US Congress on Medicare payment policy, commissioned the Center for Medical Technology Policy (CMTP) to complete a detailed review of Medicare’s experience with CED.   The CMTP report was discussed at a March 2010 meeting of the MedPAC, and this discussion provided the basis for several recommendations in the June 2010 MedPAC report to Congress.   With this posting, we have included the CMTP report, the transcript of the MedPAC discussion, and the final MedPAC report to Congress. These documents can be found at the end of this post.

The general conclusions of this program review were that the limited impact of CED as implemented by Medicare is not the result of inherent flaws in concept of CED, but can be at least partially explained by a combination of statutory, methodological, financial and timing issues. The absence of a clear statutory foundation for CED has served as a major impediment to the development of a well-articulated, coherent and consistent policy approach by Medicare. The lack of a designated source of funding to pay for the research costs of CED studies has also led to reliance on other sources of funding, which have inevitably led to compromises in study design and flaws in implementation. Overcoming these limitations and creating a well-crafted, consistent policy framework is possible, but will likely require senior level policy support for CED in the Department of Health and Human Services, or new statutory authority from the Congress to support the policy.

CER and CED in Medicare

MedPAC_March2010_Transcript

MedPAC_Report to Congress_June2010

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2 Comments leave one →
  1. March 3, 2011 7:24 PM

    We hope you’ve had a chance to look through our latest post on the MedPAC report. This topic was suggested through a comment made by Louis Jacques on our first post, Linking Payments to Outcomes.

    We are always interested in hearing your suggestions for future topics, so feel free to either post a public comment or if you prefer, you may email the site moderater by clicking on the “Contact” link in the upper right corner of the page.

  2. Logan Mardhani-Bayne permalink
    April 18, 2011 3:30 PM

    An article in the latest issue of IJTAHC that may be of interest:

    “Coverage with Evidence Development: The Ontario Experience” by Les Levin et al. reviews ten provincial field evaluation studies since 2003 and indicates that in all cases, the study addressed material uncertainty and led to a decision based on systematic review and CED data. The study addresses some of the critical success factors of Ontario’s CED experience – an interesting complement to the reports posted herein the Feb. 26 entry.

    Abstract is available at: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8251377&fulltextType=RA&fileId=S0266462311000018

    HTAi members can access the article by logging in at htai.org and clicking the journal icon.

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