An agency created by the Affordable Care Act to find the most effective medical treatments is too focused on its mission to worry about the Supreme Court’s decision on the health care law – and there may be good reasons not to dwell on the “what ifs.”

Health policy experts agree that the Patient-Centered Outcomes Research Institute (PCORI) and its $3.5 billion budget should be safe, regardless of the Court’s decision. Even if the Supreme Court repeals the entire 2010 health care law, which experts also say is unlikely, the Obama administration has the authority to create the same or similar organization – with support even from Republicans.

“Most people, including Republicans, wouldn’t think creating centers that look at ways to innovate how health care is delivered, and ways to find what treatments are best, is a hair-brain idea,” said Uwe E. Reinhardt, Ph.D., professor of political economy, and economics and public affairs at Princeton University.

The U.S. Supreme Court is expected to issue a ruling on two main issues being challenged in the ACA – the individual mandate and the Medicaid expansion – early next week. 

However, instead of dwelling on whether PCORI will remain, even if the high court decides the two issues are unconstitutional and not severable from the entire law, the agency declined to speculate on the various outcomes and said it remains solely focused on doing its work.

PCORI recently adopted its National Priorities for Research and Research Agenda – a roadmap to guide the institute’s work, and announced the funding of various projects across the country.

“We’re moving forward quickly to begin producing the information patients, caregivers and clinicians need to make more informed health care decision,” PCORI said in a statement to The Medicare NewsGroup.

Patient-Centered Research

PCORI was established by Congress, through the ACA, as an independent research institute to study, compare and find the most effective medical interventions at treating certain ailments and conditions. The goal of the effort, known as comparative effectiveness research, is to ultimately give patients and health care providers the best information on what type of care a person should receive.

Earlier this month, PCORI gave 50 research institutions in 24 states and the District of Columbia funding, totaling $30 million over two years.

“These projects will improve our understanding of how to conduct research and disseminate research findings in ways that are more responsive to the needs of patients and the health care community,”  PCORI Executive Director Joe Selby said in a written statement.

Among the projects that receive money were:

• Illinois-based Rush University Medical Center’s CAPE: Patient-Centered Quality Assessment of Psychiatric Inpatient Environments project. The project, which received $306,966, seeks to provide a nationally recognized guide for optimizing “patient-centered care” in inpatient psychiatric settings and predict outcomes of psychiatric care.
• The University of Arkansas for Medical Sciences received $604,301 for its Addressing Mental Health Needs of Rural African Americans project, which aims to gather information that can help improve the approach and delivery of care to the rural African American community in the Arkansas Delta.
• The Regents of the University of California is conducting a project that will characterize how health coaches, as members of a patient’s primary care team, help patients make more informed decisions. The project Health Team Support for Patient Informed Decision Making received $674,770.
• For more information on the projects, visit PCORI’s funded pilot projects page (http://www.pcori.org/pilot-projects/)

Although PCORI is focused on clinical effectiveness, finding the best treatment for patients may also lead to some, yet-unknown, economic benefits. 

“There’s no question that effective drugs and medicine can turn into economic savings,” Reinhardt said.

Funding Source

PCORI is funded through the Patient-Centered Outcomes Research Trust Fund, which was created by the ACA. The fund is estimated to receive $3.5 billion through 2019 from two sources: the general fund of the U.S. Treasury Department and Medicare -- $2 fees for each Medicare beneficiary are transferred each year from the Medicare Trust Fund to PCORI’s..

Its budget through 2012 totals $210 million for the first 3 years and increases to approximately $350 million in 2013, wrote A. Eugene Washington, M.D., and Steven H. Lipstein, M.H.A., two members of PCORI’s board of governors, in the New England Journal of Medicine. The funding will swell to $500 million annually for 2014 through 2019.

Despite its funding ties to the ACA, PCORI should be left unscathed with a partial repeal of the law. The issues being challenged in court are not directly connected to the funds appropriated for the agency.

‘Out of Our Control’

If by chance a full repeal of the law does occur, the Social Security Act gives the Department of Health and Human Services authority to allocate resources and establish the center itself, Reinhardt said.

It’s even more likely, he added, that Congress would simply include the financial support the agency needs in some sort of bill, such as budget legislation.

“There would be ways around it,” Reinhardt said. “In the end, I believe Republicans will probably scratch their heads and support these projects (from PCORI).”

But will it get to that point?

“The probability of that happening is very low,” he said, regarding a full repeal. “Most likely, the Supreme Court would strike down the mandate and wash their hands of it. They will say, ‘We know this will kill parts of the bill, but we’re not policymakers.’”

Nonetheless, PCORI continues to move forward.

“Congress provided us with a clear mandate to fund patient-centered and comparative clinical effectiveness research,” according to PCORI. “We’re  focused sharply on that work and we’re not distracted by issues that are out of our control.”

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