Equipment assessment strategies should be driven by specific needs

Hospital administrators and supply chain management professionals wrangle with doctors and payers over such tension-filled issues as physician brand preference, reimbursement cutbacks, budgetary shortfalls, patient demographics and clinical efficacy, to name a few, as manufacturers roll out even more advanced devices, sporting the latest bells and whistles with hefty price tags to boot.

Even with the Web, researching and strategic sourcing for the latest devices and equipment, as well as what might be coming down the pipe in development, can require at least one full-time equivalent (FTE) to manage the process.

Earlier this year, Plymouth Meeting, PA-based ECRI Institute released a white paper, "Top 10 Hospital Technology Issues: A C-Suite Watch List for 2009 and Beyond," to ease the strain of research and do a little "horizon scanning" or technology forecasting on its own.

ECRI Institute christened the top 10 technologies that will pique hospital and other healthcare facility interests starting this year, offering detailed but quick synopses of each one with catchy phrases and sentences to identify the chief concerns on part of potential buyers. They are:

1. Electronic Medical Records: What Should You Be Doing Now?

2. Ultrahigh-Field-Strength MRI and Premium-Slice CT: Do You Really Need Them? Now?

3. Physician Preference Items: Do Your Docs Know the Costs?

4. Robotic-Assisted Systems for Surgery and Endovascular Catheterization: How Many Should You Have?

5. Radiation Oncology: Will Proton Centers Fulfill Their Promise?

6. Radio-Frequency Identification Technology: What Problems Can It Really Solve?

7. Alarm Integration Technologies: How Best to Monitor All Those Alarms?

8. Hybrid Operating Rooms: How Many of Your ORs Should Have Imaging Capability?

9. Therapeutic Hypothermia after Heart Attack, Stroke, Spinal Cord Injury: Dawn of a New Era in Emergency Medicine?

10. Rapid Tests for Deadly Infections: Where Do They Fit in Infection Control Protocols?

Healthcare Purchasing News Senior Editor Rick Dana Barlow reached out to ECRI Institute analysts to help put this report into the context of a languishing recessionary economy, asking Diane Robertson, director, Health Technology Assessment Information Services, and also the primary editor on the white paper project, as well as Rob Maliff, director, Applied Solutions Group, who conducts onsite hospital consulting work, for their perspectives as well as supply chain management’s role.

HPN: If clinicians brought this wish list to their administration, what recommendations do you have for how healthcare facilities should prioritize the acquisition of any or all of these high-cost technologies, particularly during challenging economic times? 

Diane Robertson

ROBERTSON: This isn’t a wish list. The list is intended to provide some guidance on the questions and issues CEOs should be thinking about if their hospital is thinking about the technology. Our guidance is in the full white paper about what we recommend. Any particular hospital’s need and prioritization is going to depend on many factors: Local market, patient demographics, their strategic vision for their service lines. For example, some of these technologies — like the premium imaging equipment — are most useful for selected clinical indications and are overkill for other indications. So, for example, if one does not have significant services and populations needing neuro and cardio imaging, then the high-end CT and MRI would not be the best choice. Or, given that proton beam is so expensive, a number of facilities are going online with this in the next few years so the wait lists will drop dramatically, other less costly high-end radiation technologies are available, and the clinical benefit of one over the other has not been demonstrated, does it make sense to invest in a proton center? Also, if comparative-effectiveness studies are carried out – and the call for such studies is on [the Institute of Medicine’s] list that show no marked benefit for proton therapy over other radiation modalities, where will that leave proton therapy?

ROBERTSON: PPI as we define it, and as most people at hospitals define it, is not the umbrella for all these technologies. PPIs are items that are implanted in patients — like stents, discs, pacemakers, orthopedic joints. In total, they can represent a significant portion of a hospital’s budget, and if a hospital is stocking 10 different brands of something instead of four brands, for example, they may not be in a position to get optimal pricing for those items. They may be stocking them because they have 10 different physicians who each prefer a different brand of device because that’s what they’re used to using. So hospitals need to look at whether there are true clinical differences between items, discuss it with their clinical service line directors and physicians, and see what the most cost-effective solution is for the hospital. 

ROBERTSON: We folded a number of the 30 specific remaining technologies into the top 10 in a very general way, but chose to emphasize certain ones in the top 10. Accelerated partial beam irradiation for early breast cancer was on the list and got bumped from emphasis because of the larger issues with proton, but APBI is important because of its controversies in terms of long-term efficacy balanced against convenience for patients and desire to get a greater percentage of patients to complete the prescribed radiation therapy protocol after surgery for breast cancer. External beam radiation typically is delivered over four to six weeks, and APBI is delivered over a week or so. Another one was 3-D ultrasound CT mammography – an interesting new technology to watch that could be a painless alternative to standard mammography. Patient lift devices were another one because of the shortage of nurses and aids and increasing number of bariatric patients, aging workforce, and high cost of injuries and workers comp premiums. So these devices are becoming much higher priority for hospitals with some states mandating their use. It’s both a safety – for patients and for staff – and a cost issue [whether] to implement hospital- or health system-wide.

ROBERTSON: This is not going to be a choice that clinicians get to make. The message is: This is coming. Financial incentives are in place to aid technology adoption, hospitals will require it, and in the not too distant future, the ability to get reimbursed will depend on having adopted electronic medical records. In other words, not adopting EMRs can be expected to result in financial loss or penalties with payers like Medicare and Medicaid.

Rob Maliff

MALIFF: Medicare/Medicaid penalties kick in if they cannot demonstrate meaningful use; they will have to use it or lose money. If they are small offices, the Regional Extension Centers created under HITECH, as well as many consultants, can help them implement.

ROBERTSON: Supply chain needs to be in the loop for all the decisions, along with the appropriate clinical people and people who understand the clinical evidence for all of the technologies, the patient populations they serve, the populations they want to attract, and the potential reimbursement implications in the short and long-term. 

MALIFF: Supply chain management brings a unique perspective on how the manufacturer fits in with the hospital’s supplier base, its GPO relationships, on how the technology may affect use of disposables, etc.

MALIFF: No one knows for sure.

MALIFF: Each hospital is different, but the overall [technology assessment] and capital planning processes should be well developed, transparent and effective for a hospital to achieve success. Now, what is success? TA and capital planning programs should establish criteria that will be used to judge the effectiveness of the technology and its deployment at the hospital; these criteria may change for each technology, but they should be agreed to before signing the PO.