Funding medical technology in the era of the ACA

It has been my good fortune to have practiced as a physician during what I believe is truly the golden age of medical technology. Virtually all specialties and the patients for whom these specialists provide care have benefitted from the amazing number of technologic advances that have occurred over the past three to four decades.

From the continual development of new antibiotics to treat ever-resistant bacteria; to minimally invasive surgical procedures for nearly every organ in the body; to cardiac catheterization; to joint replacement; to immunotherapy and chemotherapy for malignancies and nonmalignancies; to transplantation surgery; to improved diagnostic and therapeutic radiologic procedures; to MRIs and PET scans; to the evolution of the new specialties of trauma and burn surgery; to ophthalmologic procedures which improve visual acuity, seal retinal tears or remove cataracts; to improvements in neonatal care of very premature and normal newborns; to vaccines and a huge number of other important medical innovations that I have failed to include - the advances have come so frequent that they are almost commonplace and often not even worthy of a substantial “Wow!” factor.

The specialty of dermatology has also been blessed with a series of simply amazing advances during this same time period that allow dermatologists to provide better care for patients with diseases that are extremely difficult to treat, or those who are suffering from cancers or other diseases that simply did not previously respond to conventional treatment.

From immunotherapy for psoriasis and other skin diseases; to Mohs surgery for treating difficult skin cancers; to topical steroids; to vaccinations against HPV and “shingles”; to PUVA (psoralen plus ultraviolet A therapy) for psoriasis and vitiligo; to lasers for port wine stains, hemangiomas, recalcitrant warts and benign adnexal tumors; to topical chemotherapy for treating superficial basal cell carcinomas and actinic keratoses; to immunohistochemistry which aids in the diagnosis of unusual skin diseases and cancer; to photodynamic therapy for diagnosing and treating premalignant and malignant skin diseases; to aesthetic procedures that improve the appearance of sun-damaged or aged skin, restore hair loss or remove rhytids; to faster and  improved wound-healing resulting from use of cultured epithelial autografts and better wound dressings - who could help but be amazed?

Cost of advancement

Regardless of the specialty, however, one commonality that has resulted from the multitudinous technologic advances and the improved quality and quantity of life is that they have all come at a significant cost.

While everyone applauds the improvement in both the quality and quantity of life resulting from use of these advances, there is a growing problem, in my opinion, with how to sustain payment for the ever-increasing healthcare costs associated with their use. Third-party payers have succeeded in having to only pay for a percentage of the costs of services provided largely as a function of forcing hospitals, clinics, pharmacies, physicians and patients into reluctantly accepting negotiated reduced reimbursements. How long can this system be sustained?

Much of the cost of developing new drugs and medical technologies is eventually paid for by the entities that use them. It appears to be virtually certain that the Affordable Care Act (ACA) will ultimately be implemented nationally. With implementation, will the government meet the continued financial challenges brought about by providing high-quality, high-technology care to even more people or will the costs become too great and the system implode?

If the financial burden becomes too great and reimbursements continue to decline, will the technologic innovations seen over the past several decades - supported in large part indirectly by healthcare dollars - also decline? There is a wide opposition by many people, including elected officials, to the implementation of the ACA for reasons that I will not repeat here. However, I believe the provisions of this law must be sufficiently inclusive so that technologic medical innovations can, and will, continue. Otherwise, we risk becoming a third-rate country as far as providing high-quality healthcare for its citizens.

Striking a balance

Simply put, the primary goal of this law is to provide more people with affordable healthcare coverage. This also implies, however, that a certain level of quality of care must also be provided, or else we are in danger of being a two-tiered system with the poor receiving a different level of care than those who can afford to pay more for their healthcare.

It would be most imprudent for this law to allow drug and medical technological innovations to slow due to reduced financial support provided by the government. For this reason, the whole process of how healthcare is funded and how providers are paid must be totally reevaluated. Only in that way can we ensure that funding provides appropriate reimbursement to hospitals, clinics, pharmacies and physicians who use these new technologies, allowing them to continue to stimulate medical advances that improve both the quality and quantity of life.

One way to try and solve the problem of balancing healthcare costs while also stimulating medical innovations to continue might be to take another look at other leading industrialized countries that have already implemented national health insurance. How are these countries funding their drug and medical technologies?

Until that question is answered, I believe we risk losing our significant edge in being able to provide the highest quality of care to our patients.