Evidence-based medicine (EBM) should be taken into account along with costs and evidence of value, if it has any hope of lowering healthcare costs, experts say.
A Web exclusive interview published June 19 in Health Affairs featuring EBM experts Sean Tunis and David Eddy says that when costs are not considered explicitly they tend to creep into coverage decisions in less visible ways.
Eddy, who coined the term “evidence-based” and is the founder and medical director of the Archimedes Project, said weighing care preferences is only half of what EBM entails. The other half is determined by how society weighs particular benefits, harms and costs.
“I believe that our failure to explicitly consider costs in medical decision making is the single greatest flaw in our healthcare system,” Eddy said. “We need to create measures and incentives that turn low-value things off, not just turn high-value things on. That is, we need to add some pay-for-nonperformance to the pay-for-performance.”
Tunis, the founder and director of the non-profit Center for Medical Technology Policy and former chief medical officer at CMS, said that recent strides in EBM, P4P and chronic care management should be celebrated. But “we can't delude ourselves into thinking that they offer a way to deal with the economic pressures in healthcare without having to make tough choices,” he said.