I recently received this data about trends in heart-related procedures. I'm sorry that I don't know the source, but I believe it to be one of the Massachusetts agencies (perhaps the DPH?)
The short summary is that procedures related to cardio-vascular health problems have dropped dramatically, with the exception of valve repairs. The explanation that I was given is that the use of drug-related therapies has risen, with equal or better efficacy than surgery. Perhaps those in the field would like to comment.
These are MA statewide volume trends between 2004 and 2008.
All open heart surgeries: Down 11% from 8762 to 7801.
Any CABG surgery: Down 21% from 5739 to 4553.
Valve surgery only: Up 15% from 2137 to 2448.
PCI only (stents): Down 24% from 16650 to 12613.
Vascular surgery: Down 10% from 19,834 to 17,823.
I hear also that fewer medical students are choosing to specialize in heart surgery. As noted here:
The educational process to become a Cardiac Surgeon is one of the longest in the medical field; after four years of college and another four years of medical school, aspiring Cardiac Surgeons spend five years in a general surgery residency and two or three more in a specialized cardio or cardiothoracic fellowship.
In the face of declining demand and this kind of personal commitment, and the likelihood of downward pressure on the rates paid for these procedures, it would appears that medical students are making rational decisions. On the other hand, if fewer enter the field and there is a shortage, maybe those who have chosen it will have the market power to drive up their reimbursement rates.
Paul,
ReplyDeleteI think this is merely a glimpse into the larger trend in all of medicine. It's not just pharma companies, but also device companies that are continually striving to reduce the number of invasive surgeries (at the urging of advising physicians). If you can replace an invasive surgery with a minimally- or non-invasive treatment, it typically improves outcomes and lowers costs and hospital stays. This is obviously a worthwhile goal.
From my perspective at the design inception level, insurance costs and reimbursement rates are actually secondary to the general goal of improving quality-of-life. Sure, it's still a business, but it is driven by the principal that improving lives and standard of care will pay for itself.
My husband graduated last year with his MD/PhD; his PhD focused on cardiac biomedical engineering research. Although he very much enjoyed his surgery rotations and had always envisioned himself as becoming a surgeon, he decided to choose cardiac ep as his field because of the advancements in non-surgical heart treatments and the downward trend you mention. He will have spent just as much time in his training (4 years of med school, 3 years PhD, 3 years internal medicine, 2 years cardiology, 2 years EP, 1 year post-doc)as if he had chosen the surgical route.
ReplyDeleteAs I'm sure your husband can attest, they may take the same number of years, but the amount of "time" each takes is far different. The CT fellows here routinely go over 100 hours a week. Internal medicine versus general surgery isn't much of a comparison either. Becoming a CT surgeon is a painful path.
ReplyDelete"On the other hand, if fewer enter the field and there is a shortage, maybe those who have chosen it will have the market power to drive up their reimbursement rates."
ReplyDeleteHasn't really worked for the primary care docs, especially in rural areas. For better or worse (worse for docs!), physicians have ceded control of their reimbursement to bureaucrats and big wigs. Our health care calamity will get much, much worse before it gets even a modicum better.