Tuesday, July 29, 2014

Keeping up with the Joneses

Just by casual observation, I have asserted that a hospital was more likely to acquire a surgical robot if a nearby competitor hospital had already done so.  But this was an untested conclusion, based on viewing websites and highway signs, particularly from community hospitals, like above.  So I was intrigued to see this great article by Huilin Li (Department of Population Health, New York University) and others in Healthcare.  From the abstract:


The surgical robot has been widely adopted in the United States in spite of its high cost and controversy surrounding its benefit. Some have suggested that a “medical arms race” influences technology adoption. We wanted to determine whether a hospital would acquire a surgical robot if its nearest neighboring hospital already owned one.


We identified 554 hospitals performing radical prostatectomy from the Healthcare Cost and Utilization Project Statewide Inpatient Databases for seven states. We used publicly available data from the website of the surgical robot's sole manufacturer (Intuitive Surgical, Sunnyvale, CA) combined with data collected from the hospitals to ascertain the timing of robot acquisition during year 2001 to 2008. One hundred thirty four hospitals (24%) had acquired a surgical robot by the end of 2008. We geocoded the address of each hospital and determined a hospital's likelihood to acquire a surgical robot based on whether its nearest neighbor owned a surgical robot. We developed a Markov chain method to model the acquisition process spatially and temporally and quantified the “neighborhood effect” on the acquisition of the surgical robot while adjusting simultaneously for known confounders.


After adjusting for hospital teaching status, surgical volume, urban status and number of hospital beds, the Markov chain analysis demonstrated that a hospital whose nearest neighbor had acquired a surgical robot had a higher likelihood itself acquiring a surgical robot (OR=1.71, 95% CI: 1.07–2.72, p=0.02).


There is a significant spatial and temporal association for hospitals acquiring surgical robots during the study period. Hospitals were more likely to acquire a surgical robot during the robot's early adoption phase if their nearest neighbor had already done so.


Barry Carol said...

To me, the term “keeping up with the Joneses” suggests trying to show that by buying a new car or new and better clothes or joining a country club or whatever proves that I’m as well off, in a material sense, as my neighbors are. In other words, it’s all about status and the outward perception of wealth.

The mentality behind the robot acquisition is likely different. The hospital that buys one after a nearby hospital does may be motivated mainly be a fear of losing business if it doesn’t. This could happen because either rainmaker surgeons direct more of their business to the competing hospital or because patients perceive the competing hospital as more modern and likely to provide better care. So, even if the hospital CEO and trustees don’t think it’s a good idea to buy one, it may do so anyway because they think sustaining the hospital’s business model depends on it even if medical outcomes are no better and costs are higher. I think the whole dynamic highlights the need to do everything possible to ensure that patients have accurate information about the cost and efficacy of medical technology and the treatment alternatives available to them.

nonlocal MD said...

Barry, I think this very thing happened at Paul's hospital while he was CEO - correct me if I'm wrong about the motivation, Paul. These pressures are hard to resist, which even more points to the necessity for the profession to assert some leadership, advocating for limited rollouts in a few academic centers while the device/procedure is studied. The AMC's could be chosen by lottery or a rotation.(I am speaking off the top of my head here, but there are many ways to get control of this out-of-control situation without regulators becoming involved.)