The road less taken
The road less taken
Northeastern MCO goes a different route
Making one group of patients wait longer for an experimental procedure simply because of who the payer is could place providers between a rock and a hard place.
That's why the Overholt-Blue Cross Emphysema Surgery Trial (OBEST) seeks to resolve the issue of making Medicare patients wait longer for the lung-volume reduction surgery.
OBEST has a similar design to the National Emphysema Treatment Trial, cosponsored by the Health Care Financing Administration (HCFA) and the National Institutes of Health.
Blue Cross of Massachusetts - and, by agreement, Harvard-Pilgrim Health Care - will cover the procedure for those patients in the trial's surgical arm then cover the patients who opt for surgery after six months.
Patients in the trial are briefed extensively on the design and intent of the study and the risks and benefits of both surgery and nonsurgical treatment, says Anthony Gray, MD, a pulmonologist who is a co-investigator for the OBEST trial at the Lahey Clinic in Brookline, MA.
In addition, that trial will last a total of two years, compared to NETT's five, Gray adds. After that, Blue Cross expects to know which patients should receive the procedure.
The study's designers and investigators say they felt strongly that they did not want to deny the surgery to patients who decide they want it, explains Gray. However, he acknowledges that allowing patients to opt out of the nonsurgical arm may damage the study's ability to collect comparative data.
"That may be a problem," he concedes. "But, at least at that point we will have six months' data - whether we get one-year or two-year data depends on the number of patients."
In addition, the OBEST trial is looking at a number of secondary objectives that the NETT trial is not, Gray states. By the end of follow-up, Blue Cross investigators hope to collect data on a number of factors influencing the quality of life of patients with severe emphysema. (See related story, p. 99.)
"These folks will really be studied quite well," he says. "Hopefully, by the end of this, we will be able to know what works and what doesn't work."
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