Health panel held as model for U.S.

Kaiser Health News

OLYMPIA, Wash. — When it’s judging the value of medical treatments it pays for, Washington state imposes a tough standard, the kind that might save tens of billions of dollars a year if it were applied nationally.

A panel of medical professionals compares the effectiveness and safety of new treatments and tests with standard alternatives, typically choosing the least costly if there’s no real difference. The panel’s decisions don’t apply to private health plans, but they’re binding on 750,000 residents: state employees; people insured by Medicaid, the state-federal program for the poor; and those who are receiving workers’ compensation.

The program is unique in the United States, and experts sometimes cite it as a possible model for the federal government. Studies suggest that using this approach would help eliminate inappropriate and wasteful care.

Critics, however, say it interferes with patient-physician decision-making and is a dangerous step down the road to what they consider rationed care, and it appears highly unlikely to gain support in Washington, D.C.

That seemed clear earlier this year when President Barack Obama proposed spending $1.1 billion to compare treatments. Even though there was no decision to use cost as a factor, a firestorm erupted, as some conservatives and industry groups warned that rationing was on the way. The proposal passed only after Congress made it clear that the initiative couldn’t be used to dictate decisions about insurance coverage.

Some 3,000 miles away, Washington state’s program is proceeding. In three years, its 11-person, part-time panel has made 10 decisions, denying coverage for five services. It’s turned thumbs down on virtual colonoscopy for colon cancer screening and knee arthroscopy for osteoarthritis, for example, while approving artificial-disc replacement for spinal disc disease under limited conditions. State officials say the program is saving $21 million annually and protecting patients from unproven and in some cases unsafe procedures.

The decisions sometimes have sparked strong criticism. Medtronic, a medical-device maker based in Minneapolis, was upset when the committee decided against covering implantable infusion pumps for noncancer pain.