You can’t get away from the word “value” in today’s healthcare environment. It’s in practically every headline of every blog, whitepaper, and email blast. From value-analysis teams to value-based medicine and purchasing, the word has become so commonplace, it risks losing its own value. With the continued shift away from fee-for-service medicine and toward pay-for-performance, we’ll need to embrace value as not only part of our vocabulary, but as a guide for our business practices. Along those lines, I’d like to take the opportunity this week to tell you about our business values; about how they make us the obvious choice for your health technology assessments; and about how our adherence to those values cost us $100,000.
WBUR’s “Here and Now” this week featured an article regarding the use of immunotherapies to decrease allergic reactions, specifically to peanuts.
Unless you’ve been living in a cave, you’re well aware of the significant health risks peanut allergies present to individuals. Symptoms run the spectrum from a runny nose and throat itchiness to full-blown anaphylaxis, which includes constriction of the airways, a severe drop in blood pressure (shock), and loss of consciousness. While the most common cause of a reaction is eating peanuts or food that contains them, they can also be triggered by skin contact, cross-contamination during food handling, and even inhalation of dusts or aerosols containing peanuts (Source: Mayoclinic.org). An allergic response to peanuts can occur in just minutes.
With respect to health technologies, the cornerstone of any coverage policy determination requires an understanding of the following:
Does the technology work?
Is it safe?
For whom does it work?
Whether you’re a current or prospective client of Hayes, we feel it is important for you to know our team. Throughout the year, we’ll introduce you to another valuable contributor to the Hayes mission of providing fiercely-unbiased evidence. Meet Shannon Brode.
Topics: Hayes Blog
This week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed Decision Memorandum regarding coverage for leadless pacemakers. If approved, it will provide conditional coverage for leadless pacemakers only if they are used in an approved clinical study as determined by the Coverage with Evidence Development (CED) program.
As a physician, I’ve seen fellow clinicians and supply chain professionals line up across from each other, prepared to do battle over the same piece of land. The physicians stood their ground, armed with the mission of excellent patient outcomes with high-quality care, while supply chain took aim with cost-effectiveness, tasked to “keep the doors open.” The reality is both sides are right. The shift toward pay-for-performance and value-based purchasing over the last five years is bringing healthcare to a tipping point, and it will be unsustainable for health systems to allow this divide to continue. While many forward-thinking organizations have made great strides to bridge the gap, physician and supply-chain engagement continues to be a pain point for a number of institutions. How do we get either side to wave the white flag? Let’s discuss just a few ways.
On Monday, October 31, the Mayo Clinic released a report that set the Internet abuzz with blog articles and radio pieces, all about genetic testing. The article detailed the case of approximately two dozen family members who decided to have genetic testing performed after a young relative died suddenly of a heart syndrome. The testing revealed that a number of them had a heart-related gene variant and that, according to the company’s database, they were at risk for the same heart syndrome. It was later discovered that the child died from a completely different cardiac-related genetic variant, and one that only he carried. This news came too late, however, as the family used the initial genetic testing information to have the young boy’s brother needlessly fitted with an implantable cardioverter defibrillator (ICD) with the hopes they would prevent another tragedy.
On September 30, 2016, the Office of Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS) released a memorandum. In it, Daniel Levinson details the initial results of an ongoing audit of Medicare costs incurred due to defective or recalled medical devices. For seven devices, which are as yet unnamed, the audit revealed $1.5 billion in Medicare payments, along with $140 million in copays and deductibles paid directly as out-of-pocket beneficiary expenses for services and procedures involving these failed or recalled devices.
On October 9, 1991, the U.S. Food and Drug Administration approved Videx (didanosine) as part of a treatment for human immunodeficiency virus (HIV) infection. The year before, I began working with two small insurance companies to examine the existing evidence for the treatment of HIV and AIDS, in order to provide them with unbiased information to make evidence-based coverage determinations. Additional healthcare technologies emerged, such as positron emission tomography (PET) scanning, high-dose chemotherapy, and bone marrow transplantation, requiring unbiased analysis of the research into their respective effectiveness. Based on the success of these efforts, it became apparent that there was enough interest in an evidence-based approach to coverage determinations to develop a subscription- and service-based resource for the payer environment. However, to be done correctly, it had to be on a large scale, with multiple clients and an exhaustive exploration of the research. Thus, the Hayes Medical Technology Directory was born.
There’s a long-touted assertion that it takes approximately 17 years for evidence to transition to practice in healthcare. In many cases, it takes even longer than that, and it will continue to do so until we ensure that the research answers two definitive questions: So what will be the outcome(s) of the study when completed? So what difference will that study make in improving healthcare quality, costs, or patient outcomes?