There have been fairly dramatic ebbs and flows in hospitals' interest in proton therapy, sometimes due to market forces and sometimes seemingly in response to the state of the economy. We've been carefully tracking these trends, and the recession clearly put the health care market into a holding pattern a couple of years ago in terms of new technology investment--proton therapy among the most heavily affected. As of the past six months or year, however, we've been noticing more movement in the proton therapy space, particular in a couple of different areas. First, we've been noticing a growing number of companies that cater to helping hospitals establish proton therapy centers, offering services ranging from capital fundraising, to program planning, to actual facility and program management. Given the massive endeavor required to bring proton therapy to market, it is a daunting task that most hospitals simply cannot handle without a great deal of external support and guidance. Second, there is simply a growing list of centers that have announced plans to invest in proton therapy, a good number of which have already kicked into gear the formal steps of architectural planning and even construction.
However, with this expansion comes a changing market dynamic, and it's interesting to reflect on how hospital administrators' perspectives have evolved. Looking back four or five years, the general perception in the hospital market was that proton therapy presented a potential market opportunity. With only five proton centers from coast to coast, the vast majority of hospitals perceived very little threat from the existing sites and instead saw an effectively open market for expansion. Now, however, many centers are looking at this issue in a new light. While there is still perceived opportunity and excitement given the still well-recognized clinical potential of the therapy, there is clearly a stronger sentiment that protons present a competitive market risk. As more centers are announced and come online, the regional pockets that were previously untouched by protons are now ostensibly going to fall subject to their competitive impact.
Update on the Constantly Evolving Proton Market
Modern Healthcare recently released their list of the top ten stories of 2010, as ranked by their readers. Approximately 700 healthcare executives completed the online poll describing what they believed were the most important stories of the first half of 2010. While the passage of the Patient Protection and Affordable Care Act garnered over half (56%) of votes, many other topics, primarily related to changes to healthcare delivery models and regulatory changes, displayed significant interest.
Only one clinical-related topic reached "Top Ten" status: the growing concerns related to radiation overdoses in medical testing. While only the 9th most popular choice (2% of votes), the significance of the topic cannot be ignored, even for hospital senior executives. Stories of patients receiving numerous CT scans and outrageously high doses per scan have caused many hospitals to re-examine their CT protocols and make strides toward managing proper imaging utilization. While the radiology community is only beginning to explore how to manage radiation dose, the interest shown by non-radiologists has appeared swiftly. Modern Healthcare will release their top 10 list for the entire year in December and we will have to wait to see if radiation dose can still command a top spot.
Given the need for providers to ensure appropriate utilization of radiation-enabled imaging equipment, as well as the general need to find innovative means to reduce exposure and improve communication of radiation exposure implications to patients and physicians, our sister program, the Imaging Performance Partnership, has launched expansive research studies and continually conducts webconferences on how hospitals have responded to radiation dose management. For information on radiation dose management and the Imaging Performance Partnership's national research, please click here.
Radiation Dose Among Top Ten Stories of 2010
Former Vice President Dick Cheney received a ventricular assist device last week to sustain his failing heart in preparation for a heart transplant. Mr. Cheney's heart problems have been documented in the media for some time. His past heart attacks and progressive heart failure have led to a number of hospitalizations and advanced heart procedures across the past few years. Given the implantation of a VAD, it is clear Mr. Cheney's heart failure has progressed to a severe level.
National news media have obviously covered the former vice president's procedure. But many stories have shifted in focus to discuss the therapy as a whole, rather than just Mr. Cheney's procedure. National stories like these bring newer ventricular assist devices into mainstream understanding. The New York Times, for example, covered the class of technologies today in a piece entitled A New Pumping Device Brings Hope for Cheney.
It is evident from this and other coverage that Mr. Cheney received the newest VAD on the market, the HeartMate II technology from Thoratec. Described by the Times as "about the size of a D battery and [leaving] most recipients without a pulse," this continuous axial flow device has allowed for a smaller, quieter, more wearable device while simultaneously delivering (hopefully) greater durability for patients. While Mr. Cheney appears to be awaiting a heart transplant and is thus using the device as a "bridge to transplant," the HeartMate II is also now approved as a "destination therapy" (DT) device, meaning it can be used on patients with advanced heart failure that are ineligible or unlikely to receive a heart transplant.
Here at The Pipeline, we covered approval of the HeartMate II for DT in January of this year. While most centers delivering DT care are transplant centers, we have been fielding requests about the feasibility of moving into this advanced therapy from transplant centers and non-transplant centers alike. National news coverage and media attention definitely bring VADs more into the spotlight. If your institution is considering expanding into the VAD market, please feel free to contact me at WynnP@advisory.com to discuss how Tech Insights can help you navigate Joint Commission certification, size the available VAD market, operationalize care for advanced heart failure and assess the financial risk and opportunity for your institution.