The case for ultrasound in an era of health care reform
March 24, 2014
Kevin M. Goodwin, president and CEO of Sonosite Fujifilm, is not shy when it comes to the benefits of ultrasound. He started in sales at ATL Ultrasound in 1987 and then helped lead SonoSite when it was spun-off from ATL in 1998. DOTmed News spoke with Goodwin about how this modality aligns with saving the health care system money and its growth potential going forward.
DMN: How is health care reform going to impact the medical imaging business in general and how might it impact ultrasound in particular?
KG: Absolutely everything being done to patients in the health care process is going to be reconsidered on the basis of necessity. The goal is really to take a fifth of the cost out of the health care system-and that’s a big number. Medical devices will be scrutinized and evaluated as to their overall utility. Ultrasound, for instance, is more than just a medical imaging modality: it is a tool that can be used to improve safety, enhance the quality of the patient experience, and save time and money
DMN: So you’re saying that ultrasound is also an economic tool?
KG: Yes, it’s going to be a big contributor in the long-term to save our health care system money. We see a lot of evidence of that. For example, in a study of recent Medicare data performed by KNG Health Consulting, we see the possibility of expanded use of ultrasound to diagnose injury to a person’s extremities. Even a small increase in the use of ultrasound versus other imaging modalities-just 2.5 percent-saved the Medicare program $34 million.
DMN: Do you feel like ultrasound is going to be a winner, or should be a winner, given its clinical utility and cost effectiveness?
KG: I think ultrasound systems used at the point-of-care just have too many virtues to turn down. There is plenty of evidence that they absolutely affect safety and improve cycle time to producing good clinical results at the bedside. Ultrasound enhances quality and decreases time to diagnosis. It saves patients time and money. And it can save them radiation exposure, too: ultrasound can be used as a frontline tool before other more aggressive imaging modalities. We know for example in orthopedic care, there is no reason to jump to the MRI instinctively every time a rotator cuff tear is suspected.
DMN: What do policymakers need to take into account when considering reimbursement levels for imaging procedures, especially ultrasound?
KG: I think they should be invoking more discipline on the hierarchy of use in ultrasound versus the other modalities in radiology and elsewhere, especially when there are so many downstream benefits to using ultrasound as the first diagnostic test for numerous clinical indications. In diagnosing kidney stones, we found no change between 2006 and 2010 in the use of ultrasound versus CT, even with all the discussion regarding concerns about radiation exposure and the costs of imaging services. There need to be incentives in the reimbursement system to support the clinically appropriate substitution of ultrasound.
DMN: In terms of point-of-care for vascular access procedures, obviously ultrasound, as you point out, is in a strong position to bring down health care costs, which is supported by analysis from AHRQ and other organizations. What are, in your view, the cost drivers here in terms of quality, safety, and procedure efficiencies and cost? What are the core drivers?
KG: You mention the study by the Agency for Healthcare Research and Quality in 2001, really a sentinel study regarding documenting how real-time ultrasound guidance for CVC insertion improves catheter insertion success rates, reduces the number of venipuncture attempts prior to successful placement, and reduces the number of complications associated with catheter placement.
A major complication of line placements, pneumothorax, is substantially reduced when ultrasound is used to guide the placement of the line. And while it took some time for the medical societies and others’ guidelines to catch up regarding recommending the use of ultrasound to guide vascular access, they have, and now the Centers for Medicare and Medicaid Services includes pneumothorax at the time of venous access in their hospital acquired conditions program.
SonoSite and United Bio Source did a study together that was published in the journal CHEST, which demonstrated that the increased cost per hospital stay of a pneumothorax was $2,752 and the LOS increased by 1.4 days when the patient suffered this complication. Institutions that have integrated the use of ultrasound guidance have reduced this complication to zero.
DMN: The Ultrasound First campaign seems to be getting some traction. Can you elaborate just a bit on the aim of the education effort and the potential impact it could have on the nation’s health care system?
KG: “Ultrasound First” actually came from a number of frontline physicians in emergency medicine, critical care, and orthopedic sports medicine. We listened to these physicians saying, “I couldn’t imagine practicing without ultrasound at the frontline and when I do I end up saving a lot of time and money in ways that are very simple and easy to follow.” After hearing this refrain from them, we at SonoSite took it forward to various stakeholders in the health care system. It has savings potential in the billions of dollars and applies to many specialties.
DMN: Can you give a “for instance”?
KG: Yes, we now see in orthopedic care an opportunity that is literally right under the noses of the payers. If they were encouraging frontline use, even with fee-for-service, and there were protocols that dictated the follow-on activities under different clinical conditions, the savings would be immense. Looking at emergency room and critical care, we know of two institutions on the west coast that have employed ultrasound at the point-of-care to get things done visually without going to X-rays and other tests or labor-intensive tasks. One is USC / L.A. County Hospital. The other is UCLA Critical Care, where the leading physician there has told us she saves three dollars for every one she spends on ultrasound used at the point-of-care. These are real examples and real savings. There are many instances where you would get tremendous cost advantages on the very first day of implementing an “ultrasound first” protocol.
DMN: How likely is that to happen on a broad scale?
KG: The issue is that there are people who want to fight for continued use of MRI and CT, even in situations when physicians say it is simply not needed. But more and more, physicians are able to move patients forward more safely and more efficiently using ultrasound-and those results speak for themselves.