Market and Organization Impact on Medical Technology Diffusion: Outcomes and Value

描述(由申请人提供)：新的医疗技术改善了医疗保健结果，但它也是快速上涨的医疗保健成本的主要驱动力。在一个高度发达的时代 成本、技术密集型药物，当限制医疗保健支出的增长已成为一项关键的国家任务时，至关重要的是要了解医疗保健市场的重大变化、医疗保健系统的重组和新支付政策的引入如何影响新医疗技术的采用、其临床结果及其相关成本。由于新的医疗技术被如此频繁地低效使用，而且由于提高医疗质量和抑制医疗成本增长的双重政策目标将需要更有效地使用技术，全面了解当代医疗组织、市场和支付政策如何影响技术采用是至关重要的。美国拥有强大而创新的医疗技术行业，每年都会将源源不断的高成本疗法引入医疗市场，特别是在心血管和整形外科的临床领域。这一现象发生的同时，医疗保健系统发生了巨大的变化，可能会影响技术的使用，包括医院及其母公司集成交付系统获得的医生执业数量显著增加，以及这些交付系统的规模和市场力量的增长。在这些根本的制度变革的背景下，我们的项目将研究2006-2014年间在高成本、高科技的心脏病学和骨科专业中采用广泛的创新医疗设备的情况。医疗设备是了解技术扩散动态的理想工具，因为新的、高成本的设备对市场力量、组织效应和支付政策变化特别敏感，这是设备使用发生在涉及医生和医院的单个组织“决策点”的自然结果。为了更好地理解新医疗技术的传播，我们提出了一个项目，它将使用联邦医疗保险和私人支付者数据，结合关于医疗保健市场和组织的详细年度调查数据，以追求以下三个具体目标：(1)了解市场因素，如竞争和同行行为对医生采用新技术的决定的作用，这些技术导致的相关临床结果及其相关成本；(2)评估医疗服务提供者组织变化的影响，重点是纵向和横向一体化增加所导致的变化，对新技术传播、相关临床结果和相关成本的影响；(3)调查新的支付政策如何影响新的医疗保健技术的传播，特别是联邦医疗保险共享储蓄计划，这是联邦医疗保险新的责任护理组织倡议的组成部分。该研究项目的完成将为未来的政策制定提供参考，以提高医疗创新扩散的效率和价值。

DESCRIPTION (provided by applicant): New medical technology has improved health care outcomes, but it is also the leading driver of rapidly rising medical care costs. In an era of high cost, technology-intensive medicine, when constraining the growth of health care expenditures has become a critical national imperative, it is vital to understand how substantial changes in health care markets, re-organization of health care systems, and the introduction of new payment policies impact the adoption of new medical technology, its clinical outcomes, and its associated costs. Because new medical technology is so frequently used inefficiently, and because the twin policy goals of improving health care quality and restraining health care cost increases will necessitate much more efficient technology use, comprehensive understanding of how contemporary health care organizations, markets, and payment policies influence technology adoption is essential. The U.S. has a robust and innovative medical technology industry that introduces a perpetual stream of high-cost therapies into the health care marketplace annually, particularly in the clinical domains of cardiovascular and orthopedic medicine. This phenomenon has occurred simultaneously with dramatic health care system changes that are likely to impact technology use, including a marked increase in the number of physician practices that have been acquired by hospitals and their parent integrated delivery systems, as well as growth in the size and market power of these delivery systems. In the context of these fundamental system changes, our project will study the adoption of a broad array of innovative medical devices in the high-cost, high-technology specialties of cardiology and orthopedics from 2006-2014. Medical devices are an ideal vehicle for understanding the dynamics of technology diffusion because new, high-cost devices are particularly sensitive to market forces, organization effects, and payment policy changes-a natural result of device utilization occurring at a single organizational "decision point" involving both physicians and hospitals. To improve the understanding of the diffusion of new medical technology, we propose a project that will use Medicare and private payer data, combined with detailed annual survey data on health care markets and organizations, to pursue the following 3 specific aims: (1) to understand the role of market factors such as competition and peer behavior on physicians' decisions to adopt new technologies, the relevant clinical outcomes resulting from these technologies, and their associated costs; (2) to assess the influence of health care provider organizational changes, with an emphasis on the changes resulting from increased vertical and horizontal integration, on new technology diffusion, relevant clinical outcomes, and associated costs; (3) to investigate how new payment policies have affected the diffusion of new health care technology, with a particular focus on the Medicare Shared Savings Program that is an integral part of Medicare's new Accountable Care Organization initiative. Completion of this research project will inform future policymaking to improve the efficiency and value of medical innovation diffusion.