Some products draw substantial interest from consumers despite their relative newness and lack of clinical consensus that they offer significant improvement over less expensive treatments.
The verdict is still out on Absorb, for example. A number of interventional cardiologists dismiss it as a marketing gimmick that offers little or no benefit over traditional metal stents.
Proponents of the product, many of whom participated in Abbott's clinical trial, say it allows more natural blood flow once the stent dissolves, preventing inflammation that can occur in some patients with metallic stents and keeping the artery clear for a very small percentage of patients who might have operations in that area of the heart. Blackwell at Wellmont maintains there are clear advantages for certain patients.
Intuitive Surgical's da Vinci series of robotic-assisted surgery systems has become emblematic of high-tech healthcare in hospital markets even though some studies have concluded it doesn't yield better outcomes than are achieved by conventional or laparoscopic surgery.
The American Congress of Obstetricians and Gynecologists has even suggested its outcomes may be inferior when used for routine hysterectomies, one of the most common procedures performed using the surgery system. The brand was also battered by a flurry of bad press about liability lawsuits filed by patients who say they were harmed during da Vinci procedures.
But none of this has stopped hospitals from purchasing the robotic systems or patients from expressing interest in the procedures. Intuitive shipped more da Vinci systems in 2015 than the year before, and the number of surgeries performed with them continues to rise.
One of Intuitive's new customers is Casa Colina Hospital and Centers for Healthcare, a small stand-alone facility in Pomona, Calif., that until recently exclusively provided rehabilitation services. Casa Colina spent millions of dollars to acquire a da Vinci Xi system and a Stryker Mako Robotic-Arm system for its new 31-bed medical-surgical unit that opened in April.
It's likely to take several years for Casa Colina to recover the costs of the equipment given the hospital's low volumes. But when other hospitals in the Los Angeles area are blanketing the market with ads for the technology, Casa Colina can't afford not to have it, too.
“If I as a patient wanted a partial knee replacement or my wife needed a (gynecological) procedure or a pelvic reconstruction, would I drive by a hospital that did not have the tech necessary for us to achieve our best outcomes? I'd probably drive by if it wasn't an option,” said Felice Loverso, the hospital's CEO.
Loverso acknowledged the studies questioning the clinical advantages of robotic surgery systems but said a hospital of Casa Colina's caliber must have the technology as an option to attract and retain physicians and patients, regardless of the return on investment.
“I want my physicians to have every tool available,” Loverso said. “It's my job to make sure they have those tools.”
Sillup, the healthcare marketing professor, says capital expenditures can create an incentive for providers to drum up demand. “Hospitals are beginning to look at this and say, “Well, we've invested in this equipment, we need to have it used.'”