Critical Article Analysis
Synopsis and Summary
There is constant innovation in the health care industry of the United States. As part of the innovation, new implants and devices are constantly emerging in the market. Such devices come at considerable cost, and their utilization in the hospital is primarily driven by the preference of the physician. These high value physician preference items form a large chunk of hospital expenses, a rising proportion of which is no more covered by government funded schemes like Medicare. Hence, there is a need to whether the newer high technology items introduced actually add value to the quality and efficiency of the patient treatment protocol. The effort to determine the value of an item faces challenges by way of incentives provided to physicians by the manufacturers of high value items, whether by way of remuneration or technical support. Physicians may also have financial relationships with the industry. The high cost medical products being evaluated also maintain an opaque pricing strategy, whereby it is not easy to price them. The introduction of new technology items may also fall short of actually improving patient outcomes. A way to address the anomalies in evaluating high technology and high cost items is to introduce a Medical Outcome Economic Committee (MOEC) whose mission would be to incorporate clinically proven and financially sound methodologies to evaluate new technology items with an overall aim to ensure high standards of patient care. The MOEC took into account financial parameters as well as physician recommendations to arrive at its decisions, while simultaneously interacting with industry to arrive at realistic prices. The result of enhanced interaction, scientific methodologies for assessment of new products and price negotiations have demonstrated a saving of $8 million against physician preference items for the institution (Obremskey and Jahangir).
The general theme of the authors was that it is essential to evaluate high technology items being used as physician preference items in hospitals to arrive at the real value for money for using such products. The authors took into account the possible conflicts of interest that physicians might have to evaluate high technology products, and therefore recommended a combined body of financial persons and physicians to arrive at a holistic decision regarding value for money. The overall stress of the authors was to reduce expenses while retaining patient care and efficiency (Obremskey and Jahangir).
Point of View
The paper was logical. However, it attempted to establish the value of creating a Medical Outcome Economic Committee (MOEC) from the experience of only one institution. While the paper gave the charter of duties and processes followed by the MOEC in detail, it did not explicitly prove that an approach to incorporate a MOEC would essentially result in improved effectiveness and efficiencies in treatments. While the paper claimed that $8 million were saved by the hospital that followed the framework of a MOEC, there was no positive proof that such savings would be repeatable. In essence, the authors provided a guideline for process orientation for determining the value of high value implants, but did not go on to establish the efficacy of the approach across a large sample of hospitals. Thus, the paper could be deemed to be an exploratory study towards value enhancement of physician preference items (Obremskey and Jahangir).
The issues presented in the article are: -
High technology, high cost items procured as physician preference items contribute substantially to hospital expenses.
Such items need to be evaluated for their value for money.
Physicians might have conflicts of interest while recommending or evaluating physician preference items.
A Medical Outcome Economic Committee (MOEC) consisting of multiple specialties to evaluate the physician preference items would prove effective in deriving value for money for the hospital.
Conclusions and Recommendations
Agreement or Disagreement
I agree with the recommendations of the authors. Increased technological growth invariably would lead to development of a few products that would not be absolutely essential for enhancing patient outcomes. Deep financial muscle of manufacturers would result in pressure on physicians to induct high cost, marginally effective items. The concept of value for money and a transparent multi-specialty body to evaluate new products would, therefore, go a long way in curbing costs and improving patient care outcomes.
The article is useful in understanding the impact that extraneous influences of industry may bear on the medical profession. The article highlights the ultimate reason doctors and hospitals exist – for patient care, and not for physicians. This is a lesson that is paramount to be carried in professional life ahead. If the supremacy of the patient were to be kept in mind, all other facets of hospital administration, including cost of facilities and equipment, would fall in place.
Obremskey, William T., and Jahangir, A. Alex. “Value-Based Purchasing of Medical Devices.” Clinical Orthopaedics and Related Research 470: 1054-1064. DOI 10.1007/s11999-011-2147-9. 2012. Web. April 27, 2015.