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State’s health technology board draws national press scrutiny

March 22, 2011 | By Michael McCarthy More

The Washington State program that evaluates treatments to determine whether they are safe and effective has come under harsh attack from the Wall Street Journal and has been the focus of two stories one in the Journal’s news pages and another in today’s New York Times.

The focus of all this attention is the Washington State Health Technology Assessment (HTA) program, which was established in 2006 to determine if treatments are safe and effective, based on the available scientific evidence.

The HTA’s decisions affect whether the treatments will be covered by state-funded health plans that insure about 750,000 Washingtonians, including state employees, Medicaid enrollees and prisoners.

The program is seen by many as a model for the national comparative effectiveness programs created by the new healthcare reform law, the Patient Protection and Affordable Care Act, which will compare treatments to see which are best.

In two editorials, The Wall Street Journal targeted the HTA’s decision to evaluate two methods of monitoring blood sugar levels in children with type 1– insulin-dependent–diabetes: intermittent home blood glucose monitoring with test strips and continuous glucose monitoring with a sensor placed under the skin.

With intermittent blood glucose monitoring, the child’s blood glucose levels are measured from a drop of blood drawn with a prick of the skin.

While this is considered standard practice, the HTA decided to evaluate the practice because there is controversy over how frequently blood levels should be tested and the overall effectiveness of the practice.

The committee also sought to evaluate whether the more costly continuous glucose monitoring device was safe and effective as well.

The committee met last Friday, March 18th to consider the evidence and make a decision.

On the day of the meeting, The Wall Street Journal attacked the program in an editorial entitled “The Pro-Diabetes Board: Washington state targets modern medicine. Coming soon to D.C.” I

n the editorial, the Journal editors charged that the HTA panel was “targeting the fundamental standard of diabetes care that has been the established medical consensus for at least three decades”

The panel was interested in finding ways to “scrimp” on patient care, the Journal charged.

“…political comparative effectiveness isn’t about informing choices. It’s really about taking away options,” the Journal said.

The next day, Wall Street Journal reporter Shirley S. Wang reported on the HTA’s hearing and decision. Wang wrote:

Washington is one of few states that factors cost into its health-coverage decisions, in addition to effectiveness and safety. Critics say that amounts to rationing because it can limit access for patients who need services but can’t afford them.

Critics of the program fear more cash-strapped states will implement programs similar to Washington’s, Wang wrote.

But some observers say states have little choice but to find ways to curb health costs.

“Washington is a leader in attempting to bend the cost curve while improving quality,” said Anne Gauthier, senior program director at the National Academy for State Health Policy, a nonpartisan think tank that isn’t involved with the Washington program.

Ultimately, the HTA committee decided to give unlimited approval for coverage of home blood glucose monitoring with standard test strips.

But coverage of continuous glucose monitoring devices, the panel decided, would only be covered for children who had experienced a hypoglycemic episode, a serious condition when the blood sugar levels fall dangerously low, or who are enrolled in a research study.

In response, The Wall Street Journal revisited the topic today in an editorial entitled “The Anti-Diabetes Board: The dodged bullet in Washington state“.

“Friday’s decision is a bow to the medical consensus, but the moment shouldn’t pass without noting how extraordinary it was that the board even considered the question,” the Journal editors wrote.

The HTA “ has prohibited coverage for or imposed restrictive conditions on drug-coated cardiac stents, knee replacements for osteoarthritis, ultrasounds for pregnant women, infusion pumps for chronic pain medication, lumbar fusion back surgery, hip resurfacing arthroplasty and others. Merely the spectacle of doctors forced to justify their practices, if not yet their existence, to a government board is troubling enough,” the editors wrote.

If the Washington model is adopted nationwide, the Journal warned, the “Government could create a de facto formulary for procedures and dictate other choices about how doctors are allowed to treat patients.”

In today’s New York Times reporter Andrew Pollack noted that the HTA saves the state more than $31 million a year.

Leah Hole-Curry, director of the program, defended its actions, saying they did not amount to rationing of health care.

“Rationing is where you know you need something and without it you are going to suffer but there’s not enough to go around,” she offered as a definition. In this case, she said, the program denied coverage for procedures that have simply not been shown to work.

“It’s still pretty astounding that we have individuals who say we don’t want you to look at scientific evidence in deciding how to spend taxpayer dollars,” she said.

To learn more:

Read the Wall Street Journal editorials The Pro-Diabetes Board and The Anti-Diabetes Board.
Read Shirley Wang’s WSJ article State Wrestles with Health Coverage.
Read Andrew Pollack’s article A Panel Decides Washington State’s Health Care Costs.
Visit the Health Technology Assessment program’s website: http://www.hta.hca.wa.gov/ where you can find the documents related to their glucose monitoring decision.