Devices and Diagnostics

Development, regulation, pricing, and reimbursement of medical devices and diagnostic products.

43 Ways to Leave Your Technology

Feb. 14, 2017

We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.

The Emerging Market of Smartphone-Integrated Infant Physiologic Monitors

Jan. 27, 2017

Christopher P. Bonafide,  David T. Jamison,  Elizabeth E. Foglia, 

In a JAMA Viewpoint, Christopher Bonafide and colleagues discuss the efficacy and safety of smartphone apps integrated with sensors that monitor infants’ vital signs. While the performance characteristics of these sensors are unknown to the public and the regulations around them are scarce, their sales have skyrocketed, reaching 40,000 units for a single brand of “smart sock” monitors. These companies use direct-to-parent advertising to portray their products as necessary to alert parents when something is wrong with their infants’ cardiorespiratory health, even though there are...

Transparency and Negotiated Prices: The Value of Information in Hospital-Supplier Bargaining

Research Brief
Mar. 21, 2016

How does price transparency affect negotiated prices in business-to-business markets? In the first empirical analysis of its kind, LDI Senior Fellows Ashley Swanson and Matthew Grennan estimate how benchmarking information could be useful to hospital buyers in their negotiations with medical technology companies. They explore two mechanisms for possible savings: first, by reducing “asymmetric information” about seller bargaining parameters (that is, not knowing the lowest price a seller would accept); and second, by helping hospitals solve the “agency problem” with their procurement negotiators (that is, allowing hospitals to monitor negotiator performance and restructure financial incentives). Taking coronary stents as their example, the authors look at whether hospitals that join a price benchmarking database, which contains average pricing based on data submitted by member hospitals, can achieve savings in future negotiations with suppliers.

Optimal Regulation of Medical Devices

Feb. 29, 2016

There’s no shortage of opinions about whether the FDA’s process of approving medical devices is too lax, too strict, or just right.  After all, there’s a lot at stake, both for patients and for the $110 billion market for medical devices in the U.S. But evidence, one way or another, has been sorely lacking.  A study by LDI Senior Fellows Matthew Grennan and Robert Town goes a long way toward filling that gap.

Cost Differences After Initial CT Colonography Versus Optical Colonoscopy in the Elderly

Nov. 19, 2015

Hanna Zafar, Jianing Yang, Katrina Armstrong, Peter Groeneveld

In Academic Radiology, Hanna Zafar and colleagues, including Peter Groeneveld, compare differences in total Medicare costs among asymptomatic elderly patients in the year after initial computed tomographic colonography (CTC) or initial optical colonoscopy (OC). In 2009, the Centers for Medicare and Medicaid Services stopped covering CTC screening among asymptomatic individuals based on the scarcity of data regarding differences in outcomes and costs between patients who received CTC and OC. Zafar and colleagues performed a retrospective cohort study of asymptomatic Medicare...

Diagnostic errors related to acute abdominal pain in the emergency department

Nov. 17, 2015

Laura Medford-Davis, Elizabeth Park, Gil Shlamovitz, James Suliburk, Ashley Meyer, Hardeep Singh

In Emergency Medicine Journal, Laura Medford-Davis and colleagues evaluate possible diagnostic errors and associated process breakdowns for patients who presented to the emergency department (ED) with abdominal pain. The authors conducted a retrospective chart review of adult ED patients at an urban academic hospital, using a computerized algorithm to identify high-risk patients. They considered patients to be high-risk if they presented to the ED with abdominal pain and were discharged, but returned to the ED within 10 days and were then hospitalized.  Diagnostic errors were...

Getting More Food-Allergic Young Adults To Carry Their Epinephrine: A Behavioral Economics Approach

Sep. 3, 2015

As one of the estimated 2.5% of Americans with a food allergy, deciding my next meal, snack, or even beverage is no simple task. Remembering to carry emergency epinephrine is also no walk in the park. Young adults like me are particularly vulnerable to error related to their food allergies and likely to engage in risky behavior. And despite the risk of death by anaphylaxis, few individuals with severe food allergies carry their emergency epinephrine on a daily basis.

Using Genomic Information to Improve Public Health

Aug. 11, 2015
What exactly is precision medicine? When the human genome was sequenced more than a decade ago, it began a new era of medicine that is now known as precision medicine. Initially, it was called personalized medicine; however, the word “personalized” was replaced with “precision” because it caused confusion and was misinterpreted. The goal of precision medicine is not to develop preventions and treatments that are unique for each individual. The National Research Council defines precision medicine as a medical model that focuses on “identifying which approaches will be effective for which...

Fix Pennsylvania's Medicaid Policy on IUDs

Jun. 15, 2015

Cross-posted with the Philadelphia Inquirer

Imagine a woman in labor who goes to the hospital with a delivery plan she made in consultation with her obstetrician: yes to antibiotics in labor; no to an epidural for pain control; yes to neonatal circumcision; and yes to having an intrauterine device (IUD) placed immediately after childbirth.

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