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PRIMARY CARE PHYSICIANS RANK TOP MEDICAL INNOVATIONS IN ORDER OF VALUE TO THEIR PATIENTS; ON AVERAGE, INNOVATIONS TO TREAT CARDIOVASCULAR DISEASE RANKED SIGNIFICANTLY HIGHER
Survey May Help to Better Understand Physician Practice Style; Inform Policies for Research and Development; Improve Quality Assessment
Washington, D.C. - High-tech scanning devices such as magnetic resonance imaging (MRI), and innovations to treat cardiovascular disease, were ranked as highly important in the care of patients, according to a survey of primary care physicians. At the bottom of the list are bone marrow transplants.
The survey of 225 leading general internists, published in the September/October issue of the journal Health Affairs, ranked 30 medical innovations that included technological devices, procedures and medications (see attached table of scores). On average, diagnostic and surgical procedures ranked significantly higher than medications.
The survey raises important questions at a time when the Centers for Medicare and Medicaid Services (formerly HCFA) is considering a new rule that would mandate major reductions in Medicare reimbursements to hospitals and doctors for 1,100 "innovative and frequently used" outpatient procedures such as pacemaker implantation and chemotherapy. Such plans may cause hospitals and physicians to use these innovations less.
"The need to compare the value to patients of new technologies with their effect on spending is a major source of tension among physicians, hospitals, patients, insurance companies and government policymakers," say authors Victor R. Fuchs, Henry J. Kaiser Jr. Professor Emeritus at Stanford University, and Harold C. Sox Jr., former professor of medicine at Dartmouth College and now editor of the Annals of Internal Medicine. "This is the first study to look at the relative value to patients of different innovations, as judged by leading general internists actively involved in patient care."
In a one-page survey, internists were asked to select the five to seven innovations from a list of 30 whose loss would probably have the most adverse effects on patients, and the five to seven whose loss would have the least adverse effects. Physicians' assessments were similar regardless of geographic location, personal characteristics or type of practice, according to the authors.
A few innovations elicited considerable variability in response. For example, human immunodeficiency virus (HIV) testing and treatment was the most variable, followed closely by cataract extraction, prostate-specific antigen (PSA) testing (test for prostate cancer), and opioids (such as morphine).
The authors found that high variable innovations like HIV testing were related to the characteristics of the patients the doctors see. For example, the average score for HIV testing and treatment rises sharply as the percentage of Medicaid patients increases. And physicians ranked the importance of cataract extraction and lens implant high if they treated a higher number of Medicaid patients and older patients.
In addition to patient type, physicians' age played a role in the rankings. For example, older physicians ranked the newer antidepressants as significantly less important to patients than did younger physicians.
Primary care physicians were chosen because, unlike specialists, they are in the best position to make comparisons of a variety of innovations, according to the study. The physicians were not a representative sample of all U.S. physicians, but were chosen by nomination of their peers based on how well-respected they are in the field and the credibility of their views. The physicians, were predominantly male and considerably older than the average American physician, and represented all parts of the country.
Another article in the same issue of Health Affairs reports on patients' views about technological advances. A general survey found that nearly 80 percent of Americans would take a hypothetical genetic test to predict their risk for developing Alzheimer's disease. On average, respondents said they would be willing to pay $324 for such a test. In the event of a positive test, respondents said they would sign advance directives (84 percent), get their finances in order (74 percent), and purchase long-term care insurance (69 percent). Only a third expressed concerns about the confidentiality of test information. The survey was conducted by Peter J. Neumann and James K. Hammitt, of the Harvard Schools of Public Health; Curt Mueller of Project HOPE's Center for Health Affairs; Howard M. Fillit and Jerold Hill, of the Institute for the Study of Aging, and Nii A. Tetteh and Kenneth S. Kosik, of Harvard Medical School.
Health Affairs, published by Project HOPE, is a bimonthly, multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. To obtain a copy, contact Jackie Graves at Health Affairs at 301-656-7401, ext. 255, or via e-mail, firstname.lastname@example.org. Selected articles from this issue are available free on the journal's Web site, www.healthaffairs.org.
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