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Opinion
Wini Hayes Published: 11/05/2008
A well-respected surgical group requests a new surgical device that they swear will revolutionize how surgery is performed in your hospital. The price tag is well into seven figures, with significant annual maintenance and training costs. A competing hospital is advertising to consumers that they have the device.
You analyze the potential return on investment (ROI) on this device, and it just doesn’t make sense. It’s more expensive than the technology that the hospital is currently using, and insurance companies won’t pay more for procedures done with this new device. It’s unclear how many surgeries will be appropriate applications of this device, and you question whether patient care or clinical outcomes will improve. Some surgeries have to be converted to standard surgeries midstream due to complications.
The surgeons argue that they are losing business by not having access to this new equipment, they aren’t seen as a cutting edge practice group, and prospective patients are going to the cross-town hospital instead.
If you are like most hospitals, you relent despite the negative ROI. You chalk it up to the cost of marketing and physician retention and look the other way. There’s an uneasy feeling that these resources could have been invested elsewhere, with a much bigger effect on quality of care.
Approximately 30 percent of all health care spending goes toward ineffective, redundant, or inappropriate care, and hospital basements are littered with “white elephants” that didn’t deliver on their promise. With capital resources scarce, the economy softening, and the cost of health care becoming a hot political issue, hospitals need a better way to make decisions about new, emerging, or controversial health technologies.
The solution is evidence-based technology acquisition. The Joint Commission and the Institute of Medicine have both launched initiatives to promote evidence-based medicine, and at the June 2008 Senate Finance Committee Summit on Health Care Reform, Federal Reserve chairman, Ben Bernanke, said, “More widespread application of evidence-based medicine could help health care workers make better use of the medical technology they already have to improve patient outcomes.”
An evidence-based technology acquisition process creates a disciplined framework in which to analyze new technologies based on a realistic assessment of the key questions:
These questions can be answered by evaluating the published results from clinical trials of the technology and by using objective information from independent health technology assessment organizations. When decisions about new technologies are based on evidence and unbiased information, you can be confident of acquiring those technologies that make sense for your patients and for your hospital. In addition, with a consistent, objective, analytical approach to technology acquisition instituted in your hospital, physicians will clearly know the ground rules for new technologies.
Here are some critical tips for successful implementation of evidence-based technology acquisition:
1. Form a committee. A cross-functional committee representing the C-suite, purchasing, physicians, nurses, risk management, and other health professionals should be formed, and ground rules established and communicated. Include key thought leaders from your physician population so they can evangelize the effectiveness of the committee with their peers and help gain hospitalwide buy-in.
2. Utilize high-quality objective information. Objective information is central to an evidence-based health technology acquisition process. This can be gathered through an in-house health technology assessment team or through objective research from an independent health technology assessment organization. The information used to make decisions about technology acquisition must not be influenced by the pharmaceutical or medical device manufacturing industries to avoid conflicts of interest.
3. Be consistent and transparent. The committee must evaluate each technology acquisition opportunity with the same evidence-based process, and decisions must be applied consistently. Deviations from established ground rules are a potential credibility killer.
4. Consider the ancillary costs of new technology. When analyzing ROI, costs such as staff training, disposables, power consumption, space requirements, installation costs, etc. are often overlooked. The committee needs data on the total cost of ownership for new medical devices.
5. Keep an eye on the horizon. It’s imperative to look at the development pipeline of potential competing products that may render today’s investment obsolete within one to three years. Make horizon scanning a key element of your technology assessment process.
6. Promote an evidence-based culture. It’s important for top leadership to provide clear support for the work of the committee, internally and externally, as part of a commitment to evidence. This will help gain buy-in from the clinical staff and establish the hospital as part of the cutting edge of health care reform. Communicate this commitment to evidence to the medical and health care staff, as well as the community.
At its current rate of growth, health spending will eat up one dollar out of every five dollars in the U.S. economy by 2017. The writing is on the wall—we can no longer afford capricious spending on new technologies. Without self-discipline, the health care industry risks facing dramatic changes. Significant new investments must deliver real returns in patient care and outcomes and, consequently, real ROI. Evidence-based health technology acquisition is the rational next step for any hospital that seeks to be a part of the solution.
Winifred S. Hayes, Ph.D., M.S., R.N., president and CEO, founded Hayes Inc. in 1989 in response to a growing need in the health care industry for evidence-based assessments of health technologies. Under her leadership, Hayes Inc. has become an international pioneer in providing unbiased, timely, clinically-focused, evidence-based reports to health plans, hospitals, managed-care organizations, government agencies, and health care systems. Hayes lectures and publishes as an advocate for the role that evidence-based decision making plays in improving patient outcomes and health care resource allocation.
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