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Rethinking Centers Of Excellence (And Other Well-Laid Plans)

Fri, 04/05/2013 - 9:55am
Pauline Chen, M.D.

Like operations, medications and fad diets, health care policy is usually appraised with a simple question: Does it work, or doesn’t it?

The assumption is that new regulations and practices either cut costs and improve care, or they don’t; and so, by simple extension, should be either supported or struck down.

Last month, for example, on the third anniversary of the passing of the Affordable Care Act, many a pundit and politician marked the occasion by diving headlong onto the does-it-or-doesn’t-it pigpile, freely offering their predictions of whether President Obama’s health law would work over the next 5, 10 or 15 years.

I managed to restrain myself, but I’ve certainly done my time in that fray.

Now a fascinating study asks all of us to reconsider how we judge putting health care policies into practice. Focusing on outcomes in obesity surgery, the study illustrates the breathtaking speed at which clinical medicine can progress, and how rapidly policies, along with their critics and champions, can become obsolete.

Healthcare policy is a moving target; and the most effective measures endure as “best practices” only until new research points the way to even better approaches.

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