Does variation detract from quality standards?
The move toward evidence-based medicine with a focus on standards of quality is premised on best practices in medicine, not local variations in practice. Should Medicare encourage variation on coverage policy in light of trends toward quality standards? Do we really need multiple evaluators? Although the numbers are shrinking, the program still has multiple decisionmakers assessing new technologies. Why do we need so many? What qualifications and resources are necessary for assessment of new technologies? If we are moving toward evidence-based medicine, do we need multiple entities to evaluate similar or identical evidence? Is “local” a proxy for decentralization? The device industry argues that local coverage is essential for timely access to new technologies, expressing concern about the all-or-nothing national decisions made by a large federal bureaucracy. However, do these arguments rest less on ties to geography and more on having multiple points of entry into the market? If one c
