November 8, 2011
What Happened to Innovation?
As an avid Kindle reader and someone who is often an early adopter of new technology, I was delighted to see the announcement recently that the Kindle Fire had arrived and would be an innovative addition to the growing field of e-readers and tablet electronic devices. Look out, iPad! New innovation drives more and better ideas, right? Innovative thinking results in more choices and a true push for value. This is the American way!
Nephrology has been left in the dust of innovation. Let’s take in-center hemodialysis and the technology to deliver it. Have there been substantive improvements in available equipment during the past decades, or have they been incremental? Is there competition among manufacturers sufficient to drive creativity, or is it just nibbling at the margins?
How about home dialysis therapy? Peritoneal dialysis (PD) is still performed the way it was developed more than 30 years ago with limited new approaches or technology. For home hemodialysis, equipment was created specifically to address this need. But wouldn’t it be even better if there were competitive products from which to choose that provided different features and pricing?
The lack of innovation spills over into the necessary pharmaceuticals that patients on dialysis need. Life-enhancing and clinically important medications — such as erythropoiesis-stimulating agents (ESAs), calcimimetics and others — have driven improvements in patient outcomes, but the lack of innovation and high development costs are particularly problematic in an age when publicly funded healthcare, not to mention the overall economy, is in serious trouble.
Innovation in medicine overall and nephrology in particular not only involves technology and medications but also care delivery models. Nephrologists are embedded in a fee-for-service reimbursement system that rewards individual care interactions and inhibits attempts to consider patient needs holistically. In addition, the ability to invest in proactive care that drives health rather than treating episodes of disease is severely constrained.
If at the end of the day we physicians must step up as true advocates for our patients and drive the best outcomes while stewarding the precious public funds (and trust), we need to advocate for:
1. Creating incentives for device and pharmaceutical manufacturers to want to innovate in the area of chronic
kidney disease (CKD).
2. Easing the barriers that keep innovative equipment and medications that are widely used elsewhere in the world
from being brought to the United States.
3. Aggressively pursuing creative care delivery models that include integrated and holistic care and an alignment
of clinical and financial incentives.
4. Promoting collaboration with appropriate federal agencies to ensure that the comparative effectiveness of new
delivery approaches, devices and pharmaceuticals is assessed, and when a new approach is demonstrated to
add value, it is approved and appropriate reimbursement for its use is established.
As the innovator and philosopher Buckminster Fuller said, “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
I look forward to your comments, until next time.
Striving to bring quality to life,
Allen R. Nissenson, MD
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Karen Klinger said,
November 16, 2011 @ 1:15 pm
I agree that the technology of hemodialysis as well as peritoneal dialysis needs to be updated to the 21st century. The process needs to be more efficient and more accessible. The costs of transporting patients to outpatient dialysis centers and then dialyzing them three times a week is a huge burden on the Medicare system. More public awareness is needed for funding for new technology that would make the process more cost efficient. You are absolutely right, if we can make i phones and Kindles why cant we figure out a way make dialysis more portable too.
James Madison said,
November 16, 2011 @ 2:39 pm
Agreed. There are numerous ideas out there that get shared when visiting with other colleagues. The rate limiting thought I keep having is whether new innovation creates a situation that increases costs, as ESA’s did, and serve to actually hurt the industry. The intense scrutiny brought on by the high costs of the meds hasn’t exactly been a catalyst for developing growth. Does Davita have a pathway for product development or concept development? How could these ideas be brought to market with Davita as a partner but with the inventor getting compensated?
Allen Nissenson said,
November 16, 2011 @ 2:54 pm
Excellent points- the name of the game in a world of increasing demand and constrained resources is creating value- quality/cost. We currently have an approach to this including brainstorming ideas and working with other who have innovative concepts; designing evaluations that are rigorous but reflect real world situations, using the resources at DaVita Clinical Research; conducting pilots, often using experienced clinical trials sites or our VillageHealth disease management group; and then scaling what seems to work to improve care while continuing to control costs. Not a perfect approach but one that applies the concepts of translational research to the real world.