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This article was originally published in The Gray Sheet

Executive Summary

DEVICE INDUSTRY DEVELOPMENT OF NEW TECHNOLOGY can accommodate a "paradigm shift" in the practice of medicine from acute care toward home and long-term care, Health Industry Manufacturers Association representative Stuart Eizenstat said March 29 at the first public meeting of the Clinton Administration's Health Care Task Force in Washington. Eizenstat said that "we strongly encourage our companies, the ones who manufacture medical devices, to work with home care. We do not believe that it will impede new technology if the rest of the system is designed properly." Eizenstat's comment came in response to a question from task force member and Veterans Affairs Secretary Jesse Brown, who asked "what impact would it have on research" to move from "our current acute care/outpatient care treatment modality to home care/long-term care." Eizenstat said that "we do not see the shift as necessarily negative for new technology." Eizenstat (Washington, D.C. office of Atlanta-based law firm Powell, Goldstein, Frazer & Murphy), served as head of the White House domestic policy staff in the Carter Administration and is acting as a consultant to HIMA. The task force meeting was designed to allow the public to provide input on the health care reform process. HIMA appeared as part of a panel assembled to discuss how "alternative forms of health care delivery" can "bring down costs long-term." Other organizations represented on the panel included the National Organization for Home Care, the American Health Care Association and the National Hospice Association. Under a reformed health care system, HIMA companies, according to Eizenstat, should be able to provide therapeutic products for alternative-site settings. However, he maintained that the administration's health care reform plan should not use the current Medicare/Medicaid system as a model for providing such coverage. "We should avoid the example of the Medicare program, which has not adjusted well to the advances in treatment, technologies and care centers." He maintained that "treatments or technologies performed outside traditional hospital settings are not readily sanctioned by Medicare. We urge that in your system the development of the process self-adjusts as care goes to appropriate cost-effective settings." The criteria for coverage of individual technologies was raised by Labor Secretary Robert Reich. He asked if whether "at some level...there is a technology that is no longer cost-effective even though it may contribute to saving lives" and about the "choices that society will be making implicitly as to at what point that occurs." Eizenstat concurred that such decisions must be made but noted that "the question is...who makes that decision and at what level it should be made." He stressed HIMA's position that "the federal government's role should be to use its resources to develop a centralized clearinghouse of assessment information" and that "it should let providers, patients and insurers decide how to use this information." Eizenstat reasserted other points HIMA discussed in its position paper submitted to President Clinton's transition team ("The Gray Sheet" Dec. 14, 1992, p. 6). He noted that HIMA's board on March 29 endorsed managed competition as well as a standard benefits package that would accommodate technology improvements (see preceding story).

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