Medical innovation isn't the same as it was five years ago. It isn't the same as it was one year ago. Cutting-edge advances in nanotechnology and molecular and genomic medicine seem to occur on a monthly basis. In fact, just last week, the first self-replicating synthetic cell was created. How do we make sense of news like this? What does it mean (or does it mean anything) for hospitals?
Such a dizzying pace of innovation isn't helped by the pressures of reform legislation. Hospitals are struggling to understand the potential impact of comparative effectiveness, episodic bundling, the Acute Care Episode (ACE) demonstration project, and the medical excise tax and how these products of the Patient Protection and Affordable Care Act will affect the future of their medical enterprise. The passing of reform legislation has awoken hospitals to major problems with the way they plan for clinical service line growth, as well as with the way they acquire and deploy new clinical technologies. Hospitals find themselves pressured by physicians and consumers to provide care in innovative ways and, in increasingly competitive markets, hospitals have realized that they are unprepared to make principled and deliberate decisions about which service lines to grow, which to defend, and where partnership and divestment strategies make sense. While innovation has changed over the past few years, the dollars involved and the high stakes have not. Moving forward, hospitals cannot afford to get it wrong - scarce dollars, reputations, and political capital hang in the balance at the prospect of poor investment decisions.
A New Era of Clinical Service Line Investment - Regenerative Medicine
In what has been reported as the most anticipated session of the conference, Dr. Martyn Thomas-a lead physician in the world of transcatheter aortic valve implantation (TAVI)-presented updated data from the European SOURCE registry at EuroPCR this week. This presentation, focused primarily on one-year data for patients enrolled in cohort 1 of the SOURCE registry (those who underwent transapical delivery), showed that survival rates for the two delivery methods are showing closer results than seen in previous studies.
Specifically, patients undergoing transapical delivery now show 12-month survival rates of 72% in comparison to transfemoral patients that have 12-month survival rates of 81.1%. This is greatly improved over previous comparisons that used the early studies REVIVE, REVIVAL, TRAVERCE, and PARTNER EU in which transapical performed at an abysmal 58% versus transfemoral at 74.9%.
Transcatheter Valves Showing Improved Mortality Results
Last week at the American Heart Association's (AHA) annual Scientific Sessions on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, Dr. Peter Groeneveld from the Philadelphia VA Medical Center provided insight into the impact of advanced cardiovascular technologies and rising health care costs.
In a retrospective analysis of Medicare claims data from 2003 and 2006 (abstract here on page 17), Dr. Groeneveld and colleagues found that the rising use of drug eluting stents (DES) and Implantable Cardioverter Defibrillators (ICDs) was associated with significant cost increases for patient with coronary artery disease (CAD) and congestive heart failure (CHF). The researches found that the cost increase of treating Medicare CAD patients with DES was nearly $5 billion dollars (approximately 89 percent of total growth) and the increase of treating Medicare CHF patients with ICDs was nearly $900 million (approximately 29 percent of total growth).
Though both were adding large dollars to Medicare cost, ICDs increased in direct proportion to the number of devices used. DES, on the other hand, added substantial cost beyond that of the stents themselves. In a subsequent interview with TCTMD, Dr. Groeneveld explained how medicine changes with new technologies, and that changes associated with DES included rises in imaging exams, diagnostic cardiac catheterizations, physician referrals, subspecialist evaluations, and elective hospitalizations; all adding more cost to these patients.
Some physicians, however, question the cost impact, and point to the fact that DES, by potentially avoiding restenosis or open-heart procedures, may reduce cost. At the same time, they argue, cost may not be an appropriate metric for technology that saves lives and improves quality of life.
Still, cost remains a major concern, both for providers and for payers alike. This study, which was sponsored by the NIH and AHRQ, underscores the importance of the cost issue to the federal government. We at TI are well aware of the importance of the issue for hospitals, and often work with our members to identify cost savings opportunities. Though these technologies are increasingly important in providing care to cardiovascular patients, smart utilization and standardization can help reduce their impact to the budget without compromising clinical care.