A new Health Affairs blog post speaks to the need for Medicare to collect and report data on the hundreds of thousands of hip and knee replacements it pays for each year. Medicare should report this data, as should every commercial health insurer. Indeed, we should have access to a wide range of health care data from both commercial insurers, like UnitedHealth, Blue Cross and Aetna, and Medicare. More data is needed to drive down costs and improve patient safety.
Medicare should be able to identify and address defect and safety problems with medical devices and products. It should also have a way to steer people to high-quality devices and products. But right now it can’t. Commercial insurers should collect and report these problems as well, and should be holding companies that sell defective products accountable on behalf of their policyholders. But, it’s not clear they can. How often do they do so?
When it comes to traditional Medicare, to a significant extent, Congress is to blame. It compels Medicare to cover every FDA-approved product and device that’s medically reasonable and necessary. Commercial insurers should have nothing stopping them from identifying and steering their members to quality products and devices. But, who knows whether they do or even what data they collect? While they are called for stricter rules for FDA approval and tracking of medical devices, they do not share their data, to the extent they have it, to help improve overall patient safety. Their business interests appear to outweigh the public benefit.
The Health Affairs post suggests Medicare can remedy the problem of not knowing which medical devices are defective or unsafe by collecting data on which devices are implanted on its claim form. It should. Why leave this responsibility exclusively to Medicare though? The Brookings Institute reports more than 3,000 potential deaths each year from defective medical devices and more than 50,000 serious adverse events.
Why not have a public registry that records all devices implanted, and which are found to be unsafe or defective, so that we can track and report how well they perform and notify everyone with an implanted device easily if it fails or is found to be unsafe?
The authors claim that registries are costly to implement and maintain. In this digital world, and with electronic medical records, one would think that the cost of setting up registries pales in comparison to the benefits, including easy notice of product failures to all patients, not simply Medicare patients, and better information to all insurers about the products they are paying for. Doctors should have this information available as well. The medical device industry makes a practice of giving them money and gifts as a way to market their products, and we need a strong check on that.
There is no perfect health insurance in the United States. All insurers impose large out-of-pocket costs. And, many make it hard to access care and impossible to be assured continuity of care. We should keep in mind that, while it could do better, only traditional Medicare ensures both relatively easy access to care and continuity of care and makes much of its data public.
One of the most compelling arguments for expanding Medicare, as Hillary Clinton proposes, is that it offers our only wide lens into what’s working and not working in our health care system and the power to drive system-wide change and improve quality of care for everyone. Commercial insurers should either step up to do their part for the public health or step away and support giving everyone the choice of Medicare.
Here’s more from Just Care: