With that in mind, the important lesson I learned from this lecture came not from the physician discussing the ureteroscope but from that evening’s second speaker. He was a Boston Scientific-employed health economist who spoke about the state of ureteroscopy in general and ureteroscopy with laser lithotripsy in particular. While the data he presented on the rise in the number of ureteroscopic cases was interesting, it was nothing I didn’t already know. (With national data on ESWL use decreasing, it’s only logical that ureteroscopic cases will go up).
Rather, he caught my attention when he began describing what the device maker did with that information. The company approached CMS and started lobbying for increases in reimbursement for these cases. He then showed data that the company succeeded and that the reimbursement for ureteroscopic cases increased in excess of the growth rate of the cases. Of note, it was the facility component and not the professional component that went up.)
Why would a private company lobby the government on behalf of hospitals and ambulatory surgery centers? In short, increased reimbursement means more scopes in the hands of urologists. This is yet another example of mutually aligned interests. We, as providers, get a new device in part because a company spotted a trend (the increased use of flexible ureteroscopes) and then lobbied CMS to increase the profit margin of the case on the facility side so it could sell a new product into the space. That is not a bad thing.
I certainly mean no disrespect to the product manufacturer, the health care economist who spotted the trend, the doctors who research and validate the product, or CMS for responding to the data. Rather, I think that this is a side of medicine that is not discussed but should be. In the world we live in where medical advances are often researched, tested, and advocated for not by the government but rather by for-profit companies, understanding the system makes us better consumers of the information and also better doctors.
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