A panel discusses how they navigate the technologies available for treating superficial venous disease and the factors that influence widespread adoption.
With Steve Elias, MD, FACS, FACPh
Long question, short answer: “Sooner or later it all comes down to money” as sung by Bruce Springsteen in “The Big Muddy.” This answer may seem cynical or simplistic, but most physicians don’t adopt a new platform or technology unless there is something in it for them—intellectual stimulation, notoriety, novelty, or remuneration. Most people don’t work at their job without compensation. We have seen this movie before many times. In fact, in superficial vein care, we are now realizing the algorithm of care that answers the question, “What forces most drive platform adoption in superficial vein care?” is often, “Because I can get paid.” Money talks and now some vein specialists are doing too many procedures because they can get paid. This is an issue that has been discussed in this publication and others, as well as at societal meetings. We are working on solutions. Another topic for another day.
Currently, we have reimbursed platforms that are safe, efficacious, durable, and relatively patient friendly for treating superficial venous disease. One need not feel as if they are providing inferior or substandard care to most patients most of the time with currently covered and available platforms. Yet, there are new nonreimbursed technology platforms that have some inherent advantages to patients and physicians. Some people are using them. The why and how may help answer the posed question.
We can divide physicians, and specifically surgeons and proceduralists, into three categories: (1) early adopters, (2) secondary adopters, and (3) reluctant adopters. Most proceduralists are not driven to change as long as what they are using seems to be working for them and for their patients. Most are not comfortable with feeling uncomfortable, except the early adopters. Most will adopt new platforms only if they need to or if they get paid. Yet, there are early adopters who simply embrace the new. These are the ones involved in clinical trials and platform development so that they can gain experience for their patients and themselves. They are the first wave. Reimbursement may not be an issue because their experience and their patients’ experience are gained by clinical trial support. However, these cases are the minority.
The great majority of physicians are secondary adopters. They wait for data, demand, and reimbursement. This is what drives their adoption. They wait and they wait, but their patience usually pays off for their patients and themselves. Their patients get treated with procedures, technologies, or platforms that are proven and reimbursed. Although this approach may not be as interesting or stimulating as the early adopters’ approach, it is the standard safe approach that is time-proven.
Luckily, reluctant adopters are the minority. By the time the reluctant adopters consider using new platforms, most of them have been vetted by research, time, and results. The losers of the reluctant adopter approach are both patients and physicians. The patients more than physicians because good care and new platform technology has been withheld longer by these physicians for their patients than most other patients.
It is the nature of medicine and surgery to progress and change. We all want to improve patient care. It is also the nature of new platforms to take time for data, results, and reimbursement to accumulate. There is at least a 3-year lag time from market entry to successful reimbursement for most platforms. Forces driving platform adoption are linear. Who adopts and at what point along the line of the “adoptive path” depends on the “adoptive attitude” of each individual practitioner. Some are early adopters, most are secondary adopters, and a few are reluctant adopters. But in reality, for most, the forces that drive platform adoption is the Jerry Maguire mantra, “Show me the money.” Not cynical or simplistic, merely realistic.