Medical Device Daily Associate
As calls in both the public and private sector continue to mount to make information on quality and cost in healthcare more transparent, the board of the Advanced Medical Technology Association (AdvaMed; Washington) voted Friday to adopt principles that would ultimately support such an initiative in hopes of having a voice in putting together any comprehensive program to address the issue.
AdvaMed said it supports building a transparent value-driven healthcare system to improve the quality of care and reduce unnecessary spending.
“Everyone is a healthcare consumer. Greater transparency is a win for patients and the delivery of health care overall,“ said Stephen Ubl, AdvaMed president/CEO. “Transparency supports increased consumer and provider awareness about the quality and costs associated with healthcare.“
He noted that board support for the principles was based on the understanding that greater transparency can help to ensure continued patient access to the full array of available technologies. The need for risk adjusters to remove any disincentives to treat seriously ill or non-compliant patients was also discussed, he added.
“Escalating healthcare costs have led employers to seek new ways to reduce costs in order to remain competitive in the global marketplace,“ Ubl added.
The move by AdvaMed comes as an executive order from President Bush requiring four government agencies to implement quality measurement programs awaits implementation in January.
Additionally, the transparency initiatives dovetails with Health and Human Services (HHS) Secretary Mike Leavitt's plan to connect the healthcare system through better use of information technology, including electronic health records; measuring and publishing information regarding the quality of healthcare, with a focus on patient outcomes from care; measuring and publishing prices for episodes of care; and creating positive incentives by implementing contractual arrangements that reward those who offer and purchase high-quality, competitively-priced healthcare.
AdvaMed said its principles underscore the need for transparency initiatives to strive to provide consumers with tools to make informed decisions about their healthcare. These principles urge that transparency initiatives be based on “accurate, timely and robust measures which reflect the complexity of the procedures and services available.“
The group said that such initiatives should incorporate comprehensive definitions of the benefits and costs of healthcare services, including consideration of recovery times, lost productivity from days absent from work, and other factors contributing to the overall value of the healthcare provided.
The board said it believes that any transparency initiatives should: recognize that value is based on both quality and cost; engage consumers and place minimal administrative burden on providers; assure access to technology and innovation; and require certain conditions for development and reporting of measures.
The group cautioned that greater transparency should recognize that value is a function of both quality and costs. It said that patients cannot determine the value of care based solely on its cost. It noted that public reporting of cost information, without accompanying quality measures, “may lead to unintended consequences and reductions in the quality and efficiency of care.“
Therefore, the board suggested that quality and cost measures should be tied to well-established clinical guidelines developed by appropriate physician specialty societies.
The organization did not suggest, however, that its members should have to provide data on the cost of their products to the public. Indeed many medical device companies have jealously guarded that information, and it appears unlikely that outside of a government mandate, that will change any time soon.
Rather, the board said that cost measures should be based on the resources needed to deliver a group of services, or entire episode of care. The resources, it said, should be identified from “well-established clinical guidelines.“
The group noted that transparency initiatives should focus on patients' needs for information, but did not suggest what information is needed, saying that research will be required to determine what information is useful and how it is best presented.
It did say that any transparency requires that performance differences be fairly and accurately displayed to enable informed decision-making by consumers.
The group also stressed that greater transparency must support technological innovation as well as innovation in healthcare delivery. Any transparency requirements, it noted, “should not discourage vigorous competition within the healthcare system and should also ensure continued patient access to the full array of available technologies.“
Making the case for its participation in the process, the board said that any measures used to assess quality and costs should be developed by collaboration among all stakeholders — providers, patients, innovators, and payers—in an open, public process.
The group also said that any initiative must take into account changes in best practices and advancements in technology when updating quality and cost measures
“We recognize greater access to information on the quality and cost of healthcare will enhance accountability and efficiency in the healthcare marketplace,“ said Edward Ludwig, AdvaMed's board chairman, who is also president/CEO of BD (Becton Dickinson and Co.; Franklin Lakes, New Jersey).