In case theres any lingering doubt, let it be known that post-election agenda-pushing by healthcare-policy influencers has begun in earnest. That was certainly the not-so-subliminal message received during the journal Health Affairs briefing on the cost and effectiveness of medical technology in Washington this week.
The four panelists who argued both sides of the regulation and transparency coins made it clear that the fault line separating policy advisers who call for greater or continued healthcare deregulation from those who advocate for greater controls is becoming wider in this lame-duck period. Policy experts are fine-tuning their arguments for or against portions of President-elect Barack Obamas healthcare reform proposal, which include plans for requiring medical devicemakers to disclose their prices and implementing a program that would compare the efficacy of new and existing, as well as similar, medical technologies.
The November/December issue of Health Affairs features more than 20 medical-technology articles focusing on such issues. According to the journals Editor-in-Chief Susan Dentzer, the challenge of developing healthcare policies that allow cutting-edge innovation and safe, affordable treatments to coexist is no easy feat. Even laying aside some safety concerns we have regarding some of these technology advances, we know there have been significant benefits to patients over the years, she said to a room of policy experts, researchers and journalists. Yet, one cant help but read through all the papers in this issue and wonder if their use has not gotten totally out of hand.
Whether imaging technology is overused is a question that currently has no discernable answer, said panelist Laurence Baker, a health economist and professor of health research and policy at Stanford University. Theres no question, he said, that imaging-technology use and its associated costs have skyrocketed over the past decade. Bakers study found, for example, that each new CT scanner on the market prompted another 2,224 additional CT procedures a year and each new MRI unit on the market led to 733 additional MRI procedures yearly, adding more than $1.2 million to annual Medicare spending.
But while its clear that the availability of those new technologies add costs, the conventional wisdom that financial interest is at the root of providers ordering more imaging tests is not necessarily correct, Baker argued. Theres certainly a lot of data that suggests financial interests play a role in the number of imaging procedures being prescribed, but I do have a problem with the suggestion that its the main influence on doctors using the technology, because one of the questions you have to ask is whether doctors who purchase the equipment have a different relationship with their belief in the value of imaging, he said.
Baker also argued that the tools used to assess whether the costs and safety risks associated with expanding the use of advanced-imaging procedures is acceptable dont tell us much because they dont consider a number of potential benefits beyond patient outcomes. Those benefits include doctors' ability to glean ancillary health information on their patients. Patients may also be able to avoid certain other medical care by getting a quicker diagnosis.
Ultimately, I think we need to create a better system for understanding the effectiveness of these technologies, Baker said. Weve to date relied on the market to dictate their usage and availability. A comparative-effectiveness program such as the U.K.s National Institute for Health and Clinical Excellence, known as NICE, would be a start, he said
But the suggestion that the U.S. government should play a more authoritative role in determining the dollar value and efficacy of medical technology was an anathema to some of the panelists, who felt such a move would tamp down on innovation and limit patients access to potentially life-saving technology.
NICE is a terrible proposal, said David Nexon, senior executive vice president for AdvaMed, a group representing the concerns of medical-device makers. What it says is that unless you can improve on the existing available technology, you cant get approval to market it. Also, it would add additional barriers to getting funding for developing technology, Nexon said.
Shawn Rhea reports on medical technology, medical suppliers, group purchasing organizations and healthcare news in Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.