The use – and misuse – of technology in medicine is not only a major cost driver, it is also a major cause of unnecessary pain and suffering.
Far too many carotid endarterectomies were performed in a misguided effort to reduce
If we are to have any hope of slowing down the rate of increase in medical costs, we have to stop the abuse of unproven and potentially harmful technology.
WorkCompCentral [sub req] has a great piece on a program run by the State of Washington that does just that. The Health Technology Assessment program “assesses various devices, procedures, medical equipment and diagnostic tests, then issues recommendations that public payers must follow[emphasis added]. Those public payers include the Department of Labor & Industries, which runs the state’s monopoly workers’ compensation program.”
According to an article in the New England Journal of Medicine, HTA determines reimbursement on these technologies for programs including:
“Medicaid, the workers’ compensation program, the state government employee benefit plan, and the corrections department [which] provide $2.9 billion in benefits annually to approximately 773,000 Washington citizens through direct fee-for-service plans”
Before the wingnuts start spouting about death panels, know that the HTA has been widely accepted by politicians from both parties, it passed with a single ‘nay’ vote in 2006, supported by both the state Hospital and Medical Associations, and while individual conclusions may draw opposition, the program itself is viewed very positively.
The process is rigorous. According to the NEJM;
“The program’s assessments are based on a thorough, systematic review of the evidence related to the effectiveness, safety, and cost-effectiveness of a product or service, with each type of evidence examined separately. After considering the “most valid and reliable” evidence on all three of these dimensions, the health technology clinical committee — which must be made up of practicing clinicians — arrives at one of three recommendations: covered without conditions, covered with conditions (such as criteria defining medical necessity), or not covered. The entire process must be transparent.”
HTA is important because it shows what can happen when government intervenes intelligently and carefully. So far, HTA has rendered opinions and set policy on:
* Arthroscopic surgery for osteoarthritis of the knee. (Not covered.)
* Discography for uncomplicated degenerative disk disease. (Not covered.)
* Implantable drug-delivery systems for chronic, non-cancer-related pain. (Not covered.)
* Lumbar fusion for uncomplicated degenerative disk disease. (Covered, with conditions.)
* Upright or positional medical resonance imaging. (Not covered.)
* CT colonography. (Not covered.)
* Pediatric bariatric surgery. (Not covered for patients 18 or younger. Covered with conditions for patients between the ages of 19 to 21.)
These actions have reduced costs by over $20 million since its inception three years ago.
What does this mean for you?
Payers should look closely at following Washington’s lead.
Nov
9
Joe–
We all know about useless technologies as well as drugs and various procedures which are more dangerous than therapeutic, but the moment a private payor tries to limit their use, not matter how rational and well documented the decision, the resulting “horror story” winds up on Eyewitless News and the payor is vilified in the press and local or national politicians call for investigations and so forth and so forth. Why sweet reason is allow to bloom in the state of Washington when it is brutally rooted out elsewhere is a good question for a dissertation in Political Science– or perhaps Theology.
Your comment that carotid endarterectomies,is a wast of money, A misguided and ignorant statement.I have had two successful procedures.
Great post, Joe.
THIS is what our officials in Washington should be discussing rather than the recently passed healthcare bill.
I believe we need to take an incremental approach to fixing the healthcare system.
Identify the most significant issues affecting healthcare cost & delivery; design solutions; establish targets/outcomes and oversight; implement.
Apply this plan to the first significant issue, then the second, then the third…
Gary and Michael – thanks for the comments.
Gordon – I’m happy to hear the CE procedure worked for you. I’m not sure how you define ‘successful’, nor is it clear why you required two. Was the first one not effective?
As to my ignorance, I disagree. Several studies indicate CE procedures were performed far too often on patients with questionable indications. Over the last decade the incidence of potentially inappropriate CE procedures has decreased markedly. The RAND study in the late eighties indicated about a third of the procedures performed were likely inappropriate.
If your two CE procedures were done recently, it is more likely they were appropriate, if they were less recent it is more likely they were not.
Paduda