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"Urologists frequently become enamored by the research and the unique characteristics of new technology. The business management team must ask the hard questions," writes Rick Rutherford, CMPE.
Mr. Rutherford, former director and founder of the practice management department of the AUA, has been a thought leader and writer on urology management for more than 20 years.
Adoption of new technology has always been a common characteristic in the specialty of urology. One need only take a brief tour of the William P. Didusch Center for Urologic History at the AUA headquarters in Linthicum, MD to be impressed with the technological advancement in the diagnosis and treatment of urologic conditions over the decades. In particular, digital health technology has been sweeping through all health care delivery systems in the past few years. “Adoption of these emerging technologies, while favorable, will require a high level of coordination and interoperability across the various sectors of health care,” according to a post on www.quora.com.
Urologists and their practice management teams are bombarded with new technological breakthroughs each spring at conferences such as the AUA annual meeting and AUA section meetings. This year, two examples include a high-frequency quantitative ultrasound system using a new micro-ultrasound scanner for identification of possibly cancerous prostate lesions (Ultrasound Med Biol April 4, 2018 [Epub ahead of print]) and a portable, diagnostic cystoscope with a self-contained, reusable video electronics handle and a detachable, single-use cannula with LED and high-resolution camera at the tip.
Urologists frequently become enamored by the research and the unique characteristics of new technology. The business management team must ask the hard questions. What are the practical considerations in deciding when a practice or a hospital should move to implement some of these advanced devices?
The following is a list of six criteria that should be considered prior to acquisition of new technology:
Is it FDA approved? In the U.S., no payer can pay for use of unapproved devices. This is a prerequisite for Medicare to approve an allowable fee for a new service, and this protocol is followed by all other government and commercial payers.
What is the procedure’s current reimbursement status among your major payers? Even an FDA-approved device may still be considered “investigational” by payers for a period of time, particularly if it is a technological improvement on existing treatments. Being an early adopter can wreak financial damage if providers have to convince patients to pay out of pocket for this new, improved treatment that is not covered by insurance.
How will the return on investment be affected by declines in reimbursement rates over time? Savvy practice managers who have years of experience with insurance payments realize that when a new CPT code is adopted by the American Medical Association and valued for payment by the Centers for Medicare & Medicaid Services (CMS), the reimbursement per treatment typically falls. This decline is generally based on declining estimates of practice expense and liability insurance expense as new technology becomes state of the art.
Next: What is the cost per case compared to your current approach?What is the cost per case compared to your current approach? Beware of early adopter discounts for purchase of equipment, supplies, and service agreements that may increase once the device gains widespread adoption.
Will the device improve patient safety and provide equal or improved diagnostic results and improved efficiency of treatment? All of these factors represent costs to the practice in one form or another and must be considered in purchase decisions.
What are the expected promotion costs to convince patients to adopt new technology? This might include production of videos for your website, arranging talks at community events, printed materials, etc. The worst strategy a practice can follow when adopting new technology is to purchase it and then allow it to languish because of ineffective public education about its benefits.
As urology moves into the realm of alternative payment methodologies based on shared savings, it is important to forecast whether the adoption of new devices will cause a negative effect on the cost for an episode of care. As the payment paradigm shifts, it is a good strategy to address this conundrum by considering service sharing. As the Medicare Merit-based Incentive Payment System has introduced the idea of “virtual groups,” the same model may be used by collaborators to share the overall costs of some of these new technologies while still providing the community with the latest and greatest urologic diagnostic and treatment tools.
Note: For those interested in keeping up with new technology connected with urology care, one helpful website is www.medgadget.com/urology.
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