Technical Sobriety, Health Equity, and Reprocessing

Reflections on the recent EHRA 2023 conference

“I can say with great confidence that the physical characteristics of remanufactured catheters - from reputable vendors - seem to have characteristics indistinguishable from first-use products, having evaluated them reasonably carefully”¹

These words came from Dr. Mark Gallagher of St. George’s Hospital in London at a recent session of the European Heart Rhythm Association (EHRA) in Barcelona, Spain. The April conference featured 4 sessions and 20+ presentations about sustainability and electrophysiology (EP) procedures, a string of sessions that ended with participating physicians doing a straw poll on single-use device reprocessing in the EP lab: 48 out of 50 were in favor. 

European EP physicians are not only recognizing that the relevant regulatory bodies’ determination of “substantial equivalence” of a reprocessed device and a new device matches their individual experiences using reprocessed devices - they are pushing for more use of reprocessed devices to address issues of carbon emissions and health equity. And the environment is top of the list, reflected in the number of sessions dedicated to the topic.

At the same conference, physicians spoke about their grave concern that the environmental footprint of EP procedures needs immediate attention. Dr. Josselin Duchateau from Haut-Leveque Hospital in Pessac, France, said:

“Our current healthcare system is unsustainable and incompatible with our climate goals. Yet, our environment – and the protection of our environment – is a key determinant of our health, so we must focus on it.”

And it is not just about environmental waste. Sustainability in electrophysiology is also about hospital economics and about health equity: When new technologies are adopted that simply increase the cost of procedures, population health is at risk because the hospital will not have the resources to treat all patients.

Dr. Duchateau continued,

“We need to take this problem and change it right now, and make a technical environment that must strive for sobriety. This is the only way that we’ll be able to treat all the patients we want. The alternative – if we don’t do that, if we’re unable to do that – is that we will have to select the patients that receive treatment, because we won’t have enough for everyone.”

This is my favorite commentary from EHRA. Reprocessing as a circular healthcare economy solution reduces the environmental footprint of healthcare, but circular healthcare economy solutions go beyond this and effectively address health equity – or the reach of our best medical procedures throughout the patient population.

Reprocessing as a circular healthcare economy solution reduces the environmental footprint of healthcare...

Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. In electrophysiology, technology innovation continues to drive up hospital costs. EP labs (hospitals) are under pressure from EP physicians to adopt these new technologies so they can practice at the top of their license. However, physicians like Dr. Duchateau recognize that the profession’s infatuation with the newest technology must be balanced against use of said technology in ways that continues to make the healthcare system systemically inclusive. I don’t know exactly what Dr. Duchateau meant with his statement, but I take it to mean that a “sober technical environment” is an EP lab where technology utilization is weighed against the cost of said technology, and the impact of its utilization on the lab’s ability to provide care for each patient that would benefit from an EP procedure.

Here is the grim EP health equity reality in the US: More than 50% of CMS reimbursement for an atrial fibrillation procedure is eaten up by the cost of medical technology. This probably means that atrial fibrillation procedures are unprofitable to hospitals with an unfavorable payer mix (more Medicaid and Medicare patients than private insurance patients). This means hospitals will inevitably have to be selective in terms of what patients they are treating – to ensure the EP lab can continue to operate.

More than 50% of CMS reimbursement for an atrial fibrillation procedure is eaten up by the cost of medical technology.

A health equity perspective on technology utilization in the EP lab means looking at how technology utilization impacts lab economics and patient access. When new technologies are launched at a premium price and blindly adopted by physicians, procedure costs go up and EP lab management needs to become selective in terms of patient access. When single-use device reprocessing is embraced by EP physicians, costs can be contained, environmental footprint is reduced (benefiting population health), and health equity gets a boost, because the cost per EP procedure goes down, and more patients can be cared for.

The message from EHRA was clear: Single-use device reprocessing – or any other device re-use approach that can address hospital costs - the environment and health equity need to be embraced by physicians, hospitals and MedTech providers. Let’s see how the US Heart Rhythm Society addresses this at their upcoming annual conference.

¹ Quotes from EHRA are courtesy of the Association of Medical Device Reprocessors (AMDR).