The Role of Clinical Evidence

(This is the fourth installment of a six-part series examining the role of clinical evidence in capital planning.)

Clinical evidence comes into play immediately after a capital planning team determines it’s time to acquire a particular category of equipment or device. It’s essential that the team rely upon this evidence to investigate several key areas of concern, using the same rigorous question-and-answer approach outlined above. For example:

Reimbursement:

– Will CMS and private payers cover this procedure, and for which specific clinical indications?

– At what amount?

– Will there be any resistance from certain health plans, and if so—on what grounds?

Measurable Improvements in Care:

– Is there a comprehensive and objective set of clinical evidence showing that this technology will (or won’t) deliver measurable improvements in patient care? How robust and definitive is the evidence?

– What does the evidence tell you about specific patient indicators for use?

– What does the evidence tell you about effectiveness compared to other technologies?

Why It’s Important: When a patient undergoes a procedure, it is the procedure that is being purchased—not the technology that’s delivering it. And sometimes, improvements in care apply only to a subsection of the patient base for whom the technology might potentially be used. This means the equipment might offer little attainable financial benefit to your facility—not to mention clinical benefit to the community your hospital serves.

Clinically Comparable Technologies:

– Are there any clinically comparable technologies?

– If so, how do they compare in terms of reimbursement, cost, and most importantly—measurable improvements in care and outcomes?

– Can you achieve the same budgetary, reimbursement, and clinical outcome improvements with refurbished technology instead of new equipment?

Lifecycle of the Technology:

– How long can your hospital continue to provide care before replacing your current equipment?

– What is that equipment worth on the secondary market? Can it offset your purchase of a new device?

– How and when will a new technology need to be replaced?

Associated Environmental Factors:

– Are there non-capital programs, services, training, disposables, or other associated environmental factors that must be implemented to successfully integrate this device into your hospital’s portfolio of care?

– Can your patient demographics support all these programs? Are there any competing programs in your hospital’s service area that will erode your patient base?

– What impact will purchasing—or not purchasing—the device have on your hospital’s ability to recruit and train new clinical providers?

Why It’s Important: To maximize both clinical outcomes and reimbursement from CMS and other payers, you’ll want to address any supportive programs required to optimize both patient outcomes and the ability of clinical staff to maintain proficiency. Often, if such programs are not instituted, reimbursement will be discounted or even refused.

For example, when planning to acquire a robotic surgery machine intended for laparoscopic gastric bypass surgery, you will want to consider:

  • Training and credentialing requirements.
  • Beds, lifts, and other devices and equipment designed to accommodate morbidly obese patients.
  • The volume of procedures your surgeons will need to perform to maintain proficiency.
  • Investment in dietary, exercise, and psychological counseling programs for patients.
  • The operating cost of any required disposables, which can incur additional expense for both providers and their patients.

To answer these questions, the capital planning team must conduct a comprehensive and objective review of any clinical evidence associated with this equipment—and its uses.

To access the white paper from which this post was extracted, please visit our website.

Bill Donato, General Manager, MD Buyline

Healthcare veteran Bill Donato joined TractManager early in 2017.