The latest Blues association-backed analysis of rising healthcare costs is a far more nuanced study than one issued a year ago on the same general topic, which tried to pin the blame for rising healthcare costs on hospital consolidation and new technology.
Researched by a group of independent academics and published in the peer-reviewed Health Affairs journal, the new report posits a cause-and-effect relationship between some new medical devices and rising healthcare costs (Nov. 10, p. 9). It seems to lend credence to some widely held impressions, but its real value may come if it spurs further research and debate on the processes through which we adopt new technologies.
One of the report's key findings is that much new medical innovation is simply layered onto existing technology rather than replacing it. In the case of diagnostic radiology this is particularly true; CT and MRI are often brought to bear on the same symptoms, often at the same freestanding imaging facility. The presence of the machines and the whims of physicians dictate use.
Somewhat surprisingly, that finding doesn't hold for every expensive technology. Cardiac catheterization facilities add marginal costs, as you would assume they would. However, the study found an "inconsistent" relationship between the availability of another high-cost service-neonatal intensive-care units-and higher spending.
And when a facility offers two expensive treatments for patients with cardiac disease-coronary artery bypass graft surgery and angioplasty-the procedures tended to be substituted for each other, thus subtracting costs for one while raising costs for the other.
Interestingly, the report broke out spending for commercial plans and Medicare and found that almost across the board the government spends more for technology than do private insurers.
Though they mentioned it, the researchers didn't dwell on how new technology is disseminated without a clue as to whether it's more clinically effective. In other words, are we getting better care for the money being spent? Yes, catheterization labs cost more, but they may also save lives. Does PET save more lives than CT? Now there are some worthwhile topics for research.
Let's take a look at one clinical area not covered by the study, which may illuminate this point. Colorectal cancer is the No. 2 killer among cancers, and unlike many other diseases, has been the subject of a number of national clinical studies of the various diagnostic options.
Cancer experts recommend routine screening for people 50 and older. Those without symptoms and a family history of the disease should get an inexpensive blood test every year. After five years, a more expensive exam called a flexible sigmoidoscopy should be done. After 10 years, a more expensive (up to $2,000) and invasive test, the colonoscopy, is recommended. That's the best science to date.
In the meantime, gastroenterologists are pushing more frequent colonoscopies, and radiologists, afraid of being frozen out, have responded with virtual colonoscopy, a procedure involving CT or MRI of the entire colon, costing around $800. It's not so invasive, but unlike the colonoscopy, there is no opportunity to remove polyps during a virtual exam. Also, a recent study found that virtual colonoscopy misses 27% of lesions, too high a rate to recommend it as a viable alternative. That hasn't stopped radiologists from pushing yet another test.
That's the kind of information that would be more useful for healthcare decisionmakers than merely giving credence to assumptions about the costs of new technology. Health plans should spend more of their record profits on clinical research that tells us which technologies save lives as opposed to merely detracting from insurers' bottom lines.