Medical Device Daily Washington Editor
WASHINGTON — The Advanced Medical Technology Association (AdvaMed; Washington) co-hosted a session here Wednesday to make the case that devices and diagnostics can shave meaningful dollars off the nation's healthcare bill despite persistent reports that medical advances are playing at least a proportional role in healthcare inflation. The Congressional Budget Office has weighed in on the topic on a number of occasions recently, and as far back as January 2008 made the case that the graying of the U.S. population accounts for only about a quarter of healthcare inflation (Medical Device Daily, Jan. 4, 2008) where the taxpayer dollar is concerned.
AdvaMed and its co-sponsor, the cancer consortium C-Change (Washington), used Wednesday's session to present data indicating that the role of diagnostics in healthcare could tamp down on costs associated with hospital-associated infections (HAIs) and cancer, and hence offer substantial savings. However, the raw numbers offered by the speakers on the subject of HAIs failed to account for the fact that at least some of those infections were inevitable.
Tim Ring, CEO and chairman of the board of directors for C.R. Bard (Murray Hill, New Jersey), told the audience that med-tech not only provides untold numbers of Americans with jobs that pay at least fairly solid salaries, but that it "also adds value to the healthcare system by detecting disease earlier" and curing diseases faster and less invasively than would otherwise be possible. Ring also addressed the bipartisan support the session enjoyed, given that the House Medical Technology Caucus counts both Democrats and Republicans among its members, including Rep. Anna Eshoo (D-California).
"Regardless of political persuasion, I think every member of Congress can agree" that improved outcomes and long-term savings are desirable, Ring said.
Rep. Eric Paulsen (R-Minnesota), co-chairman of the House Medical Technology Caucus, told the audience that "there is no doubt that medical technology ... has to be a component of how we're going to bend" the cost curve. He said stakeholders "should be talking about how we can grow the economy with these lifesaving technologies."
Paulsen's web site notes in a July 8 statement that he offered a bill that "adds medical technology to the list of priority topics and industries eligible for Small Business Innovation Research (SBIR) funding." The bill to which Paulsen's amendment was added, the Enhancing Small Business Research and Innovation Act of 2009, passed the House by a vote of 386-41 on July 8 less than three weeks after introduction. The Senate opted to copy the House bill and approved it by unanimous consent on July 13.
Frank Lichtenberg, PhD, a healthcare economist at Columbia University (New York), said of HAIs that the Centers for Disease Control and Prevention "has attempted to estimate the direct medical cost ... and what the benefits would be of prevention" of HAIs, pegging the cost at $28 billion to $33 billion "or even higher." He said CDC's view is that the fiscal benefit of eliminating HAIs is potentially as high as $30 billion.
"It is estimated that in 2002, there were 1.7 million infections in hospitals," most of which occurred outside ICUs, Lichtenberg said, adding that in 1993, there were "essentially zero" diagnosed cases of drug-resistant infections, but that there were about a quarter of a million cases in the U.S. by 2002.
Lichtenberg presented data drawn from a study conducted in 2004 and 2005 suggesting that tests for antimicrobial susceptibility charged under two Medicare reimbursement codes could knock down HAIs at a return on investment that would impress healthcare economists. "Drug-resistant infections are on the increase," including for tuberculosis, Lichtenberg remarked.
The tests he discussed "are about $12 and $9 dollars, so it is cheap for hospitals to perform these" tests, Lichtenberg said. However, he also noted, "only one out of 40 patients are receiving these tests." The data from 30,000 patients indicated that inpatient mortality for those tested was 1.8% vs. 3.9% for controls after controlling for several factors, and mean length of stay in the hospital fell from 6.6 days to 4.8 days.
According to the data cited by Lichtenberg, the average cost per stay for the untested was in excess of $18,000, a number that fell to slightly more than $11,000 for those who were tested under one or both codes. Overall costs were "about $7,000 lower for patients who were tested" versus those who were not, Lichtenberg observed, adding that an expansion of such testing to the entire Medicare population "would reduce aggregate costs by about $6.8 billion" a year.
Medical Device Daily asked whether there was not a portion of HAIs that would occur regardless of how sanitary the hospital environment could be made, and one of the speakers at the event, Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology (APIC; Washington), acknowledged that the percentage is not trivial. "At a recent HHS meeting, the number 70% was used" to describe the ratio of avoidable infections, she said, leaving a figure of 30% of patients whose infections were beyond any control of healthcare professionals. "There will always be a portion of patients who have that unfortunate outcome," she said.
Lichtenberg said there is also a life-expectancy argument for imaging diagnostics. "Life expectancy increased more rapidly in states where the fraction of Medicare diagnostic imaging procedures that were advanced procedures," such as MRI and CT vs. X-rays, were higher. Overall, Americans enjoyed an increase in life expectancy of roughly 2.4 years between 1991 and 2004, and the use of advanced medical imaging "increased life expectancy by about .6 to .7 years, or about a quarter of overall life expectancy gains in the U.S.," Lichtenberg said.