- Aug 15, 2019
From KevinMD.com – August 15, 2019
By John Cherf, MD, MBA, MPH and Gina Thomas, RN, MBA
Keeping tabs on the sheer volume of medical drugs and devices on the market is nearly impossible – the FDA approved a record 105 novel medical devices and 59 new drugs in 2018 alone. At the same, hospitals and physicians face ever-growing pressure to cut costs while improving quality. Many physicians make patient treatment decisions based on their own expertise and/or limited review of the readily accessible information, the processes that health systems follow to adopt new products can feel long and painful.
A systematic process can exist for physicians and health care leaders to work together to reduce the clinical decision-making process for drugs and devices. Below we outline five recommendations.
Applying clinical evidence to drug and device decisions can foster respectful debate, provide greater transparency of information, and aligns health care leaders with clinicians. However, many health care leaders aren’t trained to evaluate the validity of clinical studies and summarize findings. Instead, they turn to search engines or other resources for guidance. By working with health care leaders to improve the understanding of available evidence, physicians can help build a bridge to better understanding.
For example, consider Andexxa, an agent for the reversal of the direct oral anticoagulants (DOACs). For a health system to thoroughly consider adoption of this drug, an effective indication-based comparison requires a comparison of the full drug group indicated for the reversal of DOACs. This is followed by analyzing the advantages of each drug in that group, along with personal experiences and safety ramifications. Finally, monitoring considerations that could affect dosage must be factored in. The insight that a physician brings to each part of this process is critical.
Ask for savings targets
Physicians should remind their administrative team that they are often comfortable switching to a less costly product provided that the evidence demonstrates that outcomes will not be negatively impacted. Physicians are frequently excluded from the conversation when annual service lines (e.g., surgery or pharmacy) and/or departments (e.g., supply chain) receive their annual savings targets. Instead, physicians are simply told to “reduce costs” or “choose products that are less costly.” This gap must be closed – after all, physicians are responsible for more than 80 percent of the cost and quality decisions that impact patient outcomes.
Consider Andexxa again: The drug costs six times that of alternatives, but evidence showing superior outcomes is limited. Physicians with access to this data may recommend other alternatives, or at a minimum, restrict use until an evaluation of dosing and cost is considered before adding it to the hospital’s formulary.
Head off skepticism
The number of vendors claiming absolute superiority of their drug or device is exhausting. This often leads to cynicism on the part of health care leaders, particularly when the vendor claims they already have physician support for the product. Physicians need insight into the entire body of available clinical evidence to validate not only vendor bias, but more importantly, the quality and comprehensiveness of the studies being quoted by drug and device reps. Health care leaders depend on this level of clinical understanding from their physicians to raise questions that need answering before a drug or device is selected and broadly adopted.
Share your objections and your rationale
Health care leaders recognize that physicians have preferences based on personal experience, trust, and patient outcomes. What they need is a better understanding of the complexities—including the clinical evidence—so they can collaborate effectively with physicians on the best opportunities to optimize pricing, switch to a superior product or limit product use.
Encourage collaboration with your peers
Physicians can educate health care leaders on what data is most important when evaluating existing or new products (e.g., indications, adverse events, cost per case, and outcomes data). Both non-clinicians and health care leaders also need a working knowledge of the clinical questions that immediately jump to mind so they can learn what they should consider before presenting ‘the ask of change’ to a physician.
Facilitating discussions between physicians is invaluable when biased evidence, preferences, and implications to cost variances exist. Encouraging this open communication will present an opportunity to learn from one another, often leading to positive system-wide behavior change, shared best practices, and improved outcomes. The more physicians are involved, the greater the potential for improved care.
The original article from KevinMD.com can be found here.