James Chao, MD, of OasisMD Lifestyle Healthcare in Encinitas, Calif., discusses his thoughts on healthcare innovation and delivery in the future.
Dr. Chao is associated with University of California, San Diego. Novus Scientific CEO Stefan Sowa of Sweden added thoughts about medical device manufacturing in this age of medical cost containment.
1. Surgeons are leading innovation. Surgeons have long been at the forefront of leading new innovation, driving improvements to projects, based on our operating experience. "I don't see that changing much," says Dr. Chao. "In the past, if the procedure could be one percent better, we were willing to pay 10 percent more. Now, however, we have to go out and start proving that cost increase is justified to the patient. It has to be 1 percent or lower cost difference; so there is a net sum positive in the deal."
2. GPOs may not always provide savings. Group purchasing organizations are structured to provide cost savings on standardized materials purchasing. That concept can still work for routine materials such as gauze or a scalpel, but doesn't always make sense for specialized surgical equipment or devices like a new innovative matrix mesh.
"GPOs are based on the status quo, and innovation is being stifled because companies often don't have the larger dollars to break through, and create the marketing campaigns to get to the GPOs," says Dr. Chao. "It becomes an issue and what's disappointing is the biggest participants within the GPOs are ensconced within the academic medical centers. If we can't bring new products to them, we won't have access to leaders in the field."
3. Cost-consciousness is now the way of life. Having a cost advantage before was merely a "plus" for device companies; now it's crucial. The company must now determine how their cost compares to others and what value their product brings to the patient. "We look at the clinical benefits for patients who receive the product and then come up with a value analysis," says Dr. Chao. "Sometimes devices cost more and don't add value, so they shouldn't be adopted. We aren't quite there yet, but its coming."
4. Consumers are finding more healthcare information online. People are able to look up healthcare information online about procedures, products and options for their healthcare. "Consumers are becoming more and more aware of the opportunities and options," says Dr. Chao. "Patients come to me and ask me about what kind of mesh I put in and how I do it. They're getting this information online and then I'm able to advise them."
5. Patients will become more involved in the decision-making process. Patients are able to decide what treatment is best for them based on their individual situations. The same could be true for implants in the future.
"It really presents patients the opportunity to learn more about what is put in his or her body," says Stefan Sowa, CEO of Novus Scientific, maker of TIGR Matrix Mesh. "When patients are presented with different mesh implants and given all the information about complication rates and cost, they can make a wise decision."
6. Patients still trust their physicians. Even though there is more information on the internet, that information isn't always accurate or doesn't apply to the individual. Dr. Chao often sees patients who misunderstand their condition based on internet research and he makes recommendations to help them through their treatment.
"Once the patients understand, they know why that's not for me," says Dr. Chao. "What patients want is really what is best for them and they want the information, whether they're doing it on their own or talking to a physician. They still trust their physician if he sits them down and explains the value proposition."
7. Diagnostics and treatment are becoming more customized. In the past, it was difficult to pinpoint appropriate treatment for specific patients because there are so many variables for treatment. "Everyone's hernia repair is a little bit different," says Dr. Chao. "But now because we have EMRs, we can link to what we see other similar patients benefiting from. We can gather trends based on that data and provide better care."
8. It will be easier to collect meaningful data. With electronic data collection systems, physicians can input patient data into larger registries to find trends and patterns. "You can collect a bunch of data that is meaningful and then go from there," says Dr. Chao. "When something pops above the radar I can make a hypothesis and test it." Today, clinical quality improvement from organizations like Surgical Momentum, are helping us make comparisons and do the analysis on patient outcomes to help our patients.