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，但它也是医疗保健成本迅速上升的主要驱动力。在一个高 随着医疗保健成本的不断上升，技术密集型医疗的发展，当限制医疗保健支出的增长已成为国家的当务之急时，了解医疗保健市场的实质性变化、医疗保健系统的重组以及新的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至关重要。由于新的医疗技术是如此频繁地使用效率低下，因为提高医疗保健质量和限制医疗保健成本增加的双重政策目标将需要更有效地使用技术，全面了解当代医疗保健组织，市场和支付政策如何影响技术的采用是必不可少的。美国拥有一个强大而创新的医疗技术行业，每年都向医疗保健市场引入源源不断的高成本疗法，特别是在心血管和骨科医学的临床领域。这一现象与可能影响技术使用的重大医疗保健系统变化同时发生，包括医院及其母公司综合交付系统获得的医生实践数量显著增加，以及这些交付系统的规模和市场力量的增长。在这些基本的系统变化的背景下，我们的项目将研究从2006年到2014年在心脏病学和整形外科的高成本，高技术专业中采用广泛的创新医疗设备。医疗设备是一个理想的工具，了解动态的技术扩散，因为新的，高成本的设备是特别敏感的市场力量，组织的影响，和支付政策的变化，一个自然的结果，设备的使用发生在一个单一的组织“决策点”，涉及医生和医院。为了提高对新医疗技术传播的理解，我们提出了一个项目，该项目将使用医疗保险和私人支付者数据，结合医疗保健市场和组织的详细年度调查数据，以实现以下3个具体目标：（1）了解竞争和同行行为等市场因素对医生决定采用新技术的作用，这些技术产生的相关临床结果及其相关成本;（2）评估卫生保健提供者组织变化的影响，重点是增加纵向和横向整合所产生的变化，对新技术扩散，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，特别关注医疗保险共享储蓄计划，这是医疗保险新的责任医疗组织倡议的一个组成部分。该研究项目的完成将为未来的政策制定提供信息，以提高医疗创新传播的效率和价值。

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.