Medical technology policies should promote innovation, and other letters

The Oct. 13 cover story, “Devicemakers challenged on resistance to value-based payment,” may leave readers with the mistaken impression that AdvaMed opposes reimbursement reforms designed to provide incentives for reduced costs and higher quality when in fact, we have consistently supported such reforms, going back as early as 2008. These reforms may create an enhanced market for medical technology that will reduce cost and improve quality of care across episodes of care and will enable providers to manage more effectively the high cost of chronic illnesses.

We believe, however, these reforms should be coupled with safeguards to prevent unintended consequences such as denying patients access to treatments that are clinically appropriate but raise short-term costs, or creating a chilling effect on investment in developing new treatments and cures.

While it is appropriate for insurers to wish to ensure covered treatments deliver value, raising the evidence bar for initial coverage too high or penalizing providers who are early adopters would be a mistake. Robust evidence of safety and effectiveness is already required for approval from the Food and Drug Administration, and the requirements for gathering extensive additional evidence prior to coverage can unnecessarily deny patients access to needed treatments. To this end, our companies have invested significant resources on observational studies, registries and clinical trials to generate the evidence that will demonstrate safety, effectiveness and value.

All treatments should be assessed on a continuing basis to ensure that they offer the best options for patients, and coverage and treatment should be adjusted accordingly, but all participants in the system need to recognize that patients and the public interest are best served by adoption of policies that promote continued medical innovation.

Regarding the recent story “Reform update: 1% of patients account for 22.7% of spending, AHRQ finds”, accountable care organizations are one of the models currently being tested by the CMS that can help address the issue. In highly organized ACOs, doctors have access to a variety of cost-of-care data, thus we are able to identify those patients who are overutilizers of emergency departments and hospitals. We can follow the patients closely and assign care coaches and case managers. We have incentives to do home visits for those fragile Medicare patients not able to make it on time to the doctor's office. We call them often to make sure they are taking their meds. Patient-centered medical home structures in our practices help in the foundation of a robust care-coordination program.