This creates a problem for the hospital and the electrophysiology lab, since reimbursement barely follows the pace of price increases. In addition, the reliance on single-use devices rather than reusable devices creates an enormous carbon footprint.

The financial and environmental sustainability of electrophysiology procedures are at risk. Electrophysiologists have traditionally not considered these factors and, rather, have eagerly witnessed the launch every year of new technologies at HRS. The typical electrophysiologist has a very scientific mindset and is primarily focused on getting their hands on the technology that can help them perform best — without regard for the economics and the environment. In many cases, new electrophysiology technology isn’t really that much better than the older technology, but the electrophysiologist isn’t trained to think about whether incremental technology improvements are actually worth it.


A shift in mindset
At HRS this year, I got the distinct feeling that this is changing and that the pace of expensive innovation will have to be balanced against a different, emerging mindset of the electrophysiologist. More of our dialogue with electrophysiologists now includes concerns about the environment, and some of the best electrophysiologists in the country are becoming more careful about adopting new technology that comes with a bigger price tag.

The individual physician is in a unique position to influence decisions that impact how resources are used in healthcare. In its "Code of Medical Ethics,” the American Medical Association (AMA) writes: “Physicians’ primary ethical obligation is to promote the well-being of individual patients. Physicians also have a long-recognized obligation to patients in general to promote public health and access to care. This obligation requires physicians to be prudent stewards of the shared societal resources with which they are entrusted. Managing health care resources responsibly for the benefit of all patients is compatible with physicians’ primary obligation to serve the interests of individual patients.”

This means that the physician must not only think of the individual patient, but also of how their decision-making impacts the ability of the healthcare system in general to care for all patients and how decision-making (e.g., what devices to use) impacts the environment. In addition to a focus on the individual patient, the physician must also consider how individual patient needs and the needs of the entire population are brought together in a way that “reconfigures professionals’ accountability from patient’s advocate toward balancing a duty to society with a duty to the individual patient.”

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