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Widening gap between providers and manufacturers in electrophysiology: HRS 2022

May 19, 2022
Cardiology
By Lars Thording

The annual Heart Rhythm Society Scientific Sessions, held in San Francisco April 29 – May 1 this year, is the place to be to meet clinicians, technologists, service line management, suppliers, and scientists involved in electrophysiology, the diagnosis and treatment of arrhythmias in the heart. As a clinical area, electrophysiology has grown rapidly and substantially over the past 15 years and is expected to continue growing as demographics shift and more and more patients get diagnosed.

At hospitals with a favorable payer mix and top-notch electrophysiology facilities, the electrophysiology service line has also become one of the most profitable. It can enable hospitals to maintain less profitable service lines and still end up with positive operating profits, which is not something hospitals can take for granted in the post-pandemic era. Device costs associated with electrophysiology procedures are very, very high — often more than 50 percent of the CMS reimbursement rate for an atrial fibrillation procedure. Some single-use electrophysiology devices cost more than $3,000.

The combination of high device prices, growing demand, and importance to hospital profitability suggests that the medtech industry would be extraordinarily invested in this space, and HRS 2022 certainly demonstrated that: The global giants of the medtech industry showed up with extravagant, oversized displays — sometimes several stories tall — to present the newest technologies. Abbott, Biosense Webster, Boston Scientific, Medtronic, and Philips all offered up new and improved technologies, although many seemed to offer little in terms of demonstrated improvements in patient outcome.

This is a somewhat bizarre phenomenon in medical technology: For example, a new mapping catheter is launched with added dimensionality, improved electrode configuration and better image quality. But the clinician doesn’t obtain better results. Often, the last-generation device, in spite of its technological inferiority, did the job just as well. This is like buying a car that can go 150 mph instead of 110, but since you can only go 75 mph on the freeway, it still takes 30 minutes to get to work.

Given the importance to hospital economics of electrophysiology procedures, you would think that providers would reject the replacement of older technologies with newer ones. New technologies are always more expensive and add to the high cost of devices in electrophysiology procedures. And certainly, as a veteran HRS participant, I have noticed a change in how clinicians and hospitals respond to new technology launches. Traditionally, clinicians have wanted to get the newest technologies in their hands as soon as possible — after all, to use the newest technology means being on the top of your profession. However, this is not necessarily true anymore. At HRS 2022, we saw several examples of new technologies launched within the last few years that simply had never taken off.

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