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Focused Ultrasound

October 23, 2014
From the September 2014 issue of HealthCare Business News magazine

By Neal Kassell

The tides of health care delivery are turning. As the fee for-service structure shifts to a population based accountable care organization model, we expect to see the emergence of a more balanced, value-based health care ecosystem. Payors will seek ways to decrease cost, while patients will become active participants in their care, demanding improved outcomes that mean a quicker return to their daily lives. To meet these demands, individual hospitals mand larger systems alike will look to invest in diagnosis and treatment innovations to meet the future needs of our evolving medical system. However, many of these devices and associated procedures are stalled in various stages of research and development. We must find a way to accelerate the pace to commercial success as hospitals strive to achieve the ACO model’s population-based health goals.

One way to help achieve the goals of improving the quality of care and reducing costs is by minimizing complications associated with traditional/open surgery, which are estimated at up to $25 billion annually. Fortunately, there are a number of less invasive options offering fewer risks currently available or in development. The challenge is that there is a pervasive culture in our health care system that is adverse to innovation, resulting in a lagging adoption to new approaches that ultimately widens disparities in care delivered across the country. A Johns Hopkins University study recently published in the British Medical Journal reveals the under- utilization of minimally invasive surgery in the U.S. (Cooper et. al., 2014). In studying four common minimally invasive procedures (appendectomy, colectomy, hysterectomy, and lung lobectomy), they found that mean hospital utilization rates ranged from 71 percent to as low as 13 percent. The authors concluded that, despite reductions in pain, infections and risk of subsequent surgery, adoption of minimally invasive procedures is wildly inconsistent. Higher utilization is loosely associated with urban location, larger hospital size and teaching hospitals; however, no clear trends were apparent.

Learning the lessons of innovation
As one of the early champions of the Gamma Knife, I have witnessed the challenges of integrating a noninvasive treatment approach into patient care firsthand. Systemic barriers can slow adoption of new technology by health care professionals to a glacial pace. The Gamma Knife was invented in 1951 as a promising tool in noninvasive radiosurgery, yet wasn’t commercially available in the U.S. until 1987. That’s 36 years of painstaking research, regulatory hurdles and bureaucratic red tape; all the while patients were denied access to a better treatment. Now the Gamma Knife and other stereotactic radiosurgical technologies are mainstream in hospitals, being used to treat movement disorders, arteriovenous malformations, brain tumors, epilepsy, and many more conditions.

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