ECRI Advises Plans on Top Technologies for 2010

The ECRI Institute has become a major force in evaluating the cost and effectiveness of new health care technologies.  It recently issued a report on the top ten technologies for health plans to track in 2010.  (ECRI Paper) The list starts with genetic testing, EMRs, EHRs, and PHRs and moves on to premium imaging modalities such as MRI and CT scanning, orthopedic implants, radiation oncology methods such as proton beam therapy and CyberKnife and finishes with robotic surgery and therapeutic hypothermia.

All these technologies, except the EMR/EHR/PHR, have several things in common:  they have a significant per treatment cost and have high total costs; they are heavily marketed to consumers and to physicians or hospitals; and, most importantly, they have scant evidence of benefit beyond traditional treatments.  Collectively they are adding tens of billions of dollars to health spending, and will add tens of billions more in future years, all with no randomized clinical trials demonstrating better health outcomes or better cost efficiencies.  EMR/EHR/PHR makes the list not because of potential cost to payers but because to reap the benefits, clear standards, coordination among systems and education and training are necessary.

Reading the report one is struck that perhaps instead of spending $20 billion on EMRs and $1 billion on comparative effectiveness, we should have reversed the numbers.  In the absence of clear clinical trial results to guide physicians they are prone to order the newest and usually most expensive products and services and in some cases they have a personal financial incentive to do so.  There is legitimate concern about the effect of rationing of health services; there should be equal concern about patients being subjected to products and procedures with no proven superior utility; products and procedures which may put them at increased risk, such as too much radiation exposure or the anxiety of a misleading genetic test outcome.  And the cost of all these relatively unproven services is what drives total health spending to the point that various forms of implicit and explicit rationing are considered.