Initially, the research probably would focus on new treatments that have not been widely adopted. But common treatments that are debated within the medical community - such as surgery versus physical therapy for bad backs - also could get scrutiny.
In the future, some experts say, approved medical tests and treatments could be treated the same way prescription drugs are now: Patients would pay little or nothing for generic drugs or "high value" procedures and higher co-payments for treatments judged to be of "low value."
Medicare does not explicitly take costs into account. It bases coverage decisions on whether a new treatment is "reasonable and necessary." Supporters of adding cost considerations to the equation - using "comparative effectiveness" research - say the goal is to develop a knowledge base that government programs and private insurers can rely on to guide decisions.
"People have pointed out that a lot of the care in our system is inefficient, wasteful or inappropriate - maybe 20 percent or 30 percent. The problem is, it doesn't come tagged," said Sean Tunis, Medicare's former chief physician. "So any efforts to restrain spending on unnecessary care are going to involve difficult decisions depriving people of things they need or think they might need. We haven't been very honest about it, and we haven't figured out a good way to do it."
Prostate cancer, which occurs in older men, illustrates both the potential savings and the potential controversy of the "best value" approach.
If the cancer is discovered before it has spread, doctors and patients have several options. They can choose so-called "watchful waiting" to see how the normally slow-growing tumor progresses. Chemotherapy is another possibility. But radiation is increasingly the option of choice because of the relatively lower level of side effects.
Three-dimensional CT-scan images are used to aid in focusing X-rays on the tumor while sparing surrounding tissue.
Over roughly the past five years, intensity-modulated radiation therapy, commonly called IMRT, has become practically standard in this country. But a panel of scientists, including Tunis, recently conducted a study comparing IMRT to an early radiation regimen called 3-D CRT.
The panel analyzed medical studies on the two treatments. The conclusion: Both were about equally effective at zapping tumors and preventing the cancer from returning.
