Payers eye cooperative technology assessment

Diagnostic imaging manufacturers face problems if major insurersproceed with plans to consolidate their medical technology assessmentsefforts, according to Bobby J. Bowen, vice president of GE MedicalSystems' advanced technology division.

The joint insurance company effort could centralize tremendouspower among groups that place cost control ahead of the medicalefficacy of emerging technologies, Bowen said. He addressed theNational Symposium on the Economics of Diagnostic Imaging in Washington,DC, last month.

The trend could raise more barriers to reimbursement of newimaging applications and force manufacturers to underwrite additionalresearch evaluating the cost implications of the technology theycreate, he said.

"Tying payment directly to cost-effectiveness is a significantphilosophical departure from the former standard of clinical usefulness.For manufacturers, this represents a major new hurdle for entryof products into the radiology market," he said.

The source of Bowen's concern is a joint effort by Aetna, Cigna,Kaiser-Permanente Health Plan, Metropolitan, Prudential and TheTravelers insurance companies and several Blue Cross/Blue Shieldplans. Those companies recently agreed to centralize all medicaltechnology assessments for their members.

The group is considering two plans of attack, Bowen said. Oneis a private-sector approach limited to the insurers. The otheris a public/private partnership in cooperation with the Agencyfor Health Care Policy and Research, the medical technology assessmentbranch of the federal Public Health Service.

The group would establish a central clearing house to collect,evaluate and distribute information about the safety, efficacyand cost-effectiveness of emerging diagnostic imaging technology.It would finance additional research on these topics and makeresults available to payers, providers and the general public.

The plan continued to send shock waves through the imagingmanufacturing sector even after the effort was stalled by theBush administration and the Office of Management and Budget, Bowensaid.

"The idea of a single, centralized group of omniscientgurus deciding what is good and bad for health care is frightening,"he said.

Disclosure of the insurance companies' plan came on the heelsof several other developments that could complicate the introductionof new diagnostic technology, Bowen said. Among these are theHealth Care Financing Administration's use of cost-effectivenesscriteria for granting Medicare reimbursement, the increasinglycostly and time-consuming FDA approval process, and dwindlingfinancial support for university-based radiological research.

These trends may force the manufacturers to take the same routethe insurers are contemplating, Bowen said.

"The industry may have to look at setting up some sortof consortium activity to cut the total research time and costby sharing data," he said.

Bowen itemized five priorities for industry attention. Manufacturersshould underwrite the training of radiology researchers; use theirmedical advisory boards to assess research priorities and methods;influence health-care outcomes policy-making; develop their ownoutcomes data; and continue close surveillance of new technologydevelopments, he said.