Patient-Centered Outcomes Research Institute
|Joe V. Selby, MD, MPH Executive Director|
The Patient-Centered Outcomes Research Institute, also known as PCORI, is a United States based non-governmental institute created as part of a modification to the Social Security Act by clauses in the Patient Protection and Affordable Care Act. It is a government-sponsored organization charged with investigating the relative effectiveness of various medical treatments. Medicare may consider the Institute’s research in the determining what sorts of therapies it will cover.
The Patient-Centered Outcomes Research Institute was established by the 2010 Patient Protection and Affordable Care Act.
The body is charged with examining the "relative health outcomes, clinical effectiveness, and appropriateness" of different medical treatments by evaluating existing studies and conducting its own. Its nineteen member board includes patients, physicians, nurses, hospitals, drug makers, device manufacturers, insurers, payers, government officials and health experts. It will not have the power to mandate or even endorse coverage rules or reimbursement for any particular treatment. Medicare may take the Institute’s research into account when deciding what procedures it will cover, so long as the new research is not the sole justification and the agency allows for public input.
The law governing the Institute prohibits it from developing or employing "a dollars-per-quality adjusted life year (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost effective or recommended". This makes it different from the UK's National Institute for Health and Clinical Excellence, which determines cost-effectiveness directly based on quality-adjusted life year valuations.
According to Cecilia Rivera Casale, Senior Advisor for Minority Health at the Agency for Healthcare Research and Quality, PCORI "will have the opportunity to work with researchers to develop methodologies for addressing the specific needs of priority populations that traditionally have not been the focus of randomized controlled trials. This work is part of a more general effort to develop more pragmatic, less time-consuming research methods appropriate for these populations."
PCORI is funded through the Patient-Centered Outcomes Research Trust Fund (PCORTF), which was authorized by Congress as part of the Patient Protection and Affordable Care Act of 2010.
PCORI receives income from two funding streams:
- the general fund of the Treasury and
- a small fee assessed on Medicare, private health insurance and self-insured plans. The act mandates a $2 fee, adjusted by inflation, for each person covered on a group plan.
Critics contend that as a nonprofit, PCORI does not have oversight of other federal organizations and it duplicates existing federal agencies work.
Congress established PCORI as a private, non-profit corporation, not as a federal agency, and funded this private corporation with a new federal tax, the “PCORI Fee.” which will collect an estimated 3.5-4.5 billion dollars through 2019. The organization will not have to get annual appropriations from Congress and will not be subject to the usual financial controls imposed on federal agencies. Critics charge that PCORI receives only a cursory annual review by the Comptroller General, who also appoints PCORI’s board.
PCORI's duplicates other federal agencies work. Federal agencies already engage and supports similar comparative effectiveness research that PCORI is involved with. Comparative effectiveness research activities had already been boosted by the Stimulus Act of 2009, which gave a special appropriation of $1.1 billion to the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Secretary of Health and Human Services. Congress requires PCORI to distribute a certain amount of its funds back to the government’s Department of Health and Human Services.
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