Value Analysis Cautions and Considerations

Value Analysis professionals should be aware that medical sales reps view you as targets. Sales growth plans are being redefined by manufacturers, and consultants who educate sales reps on pathways into hospitals. Value Analysis is a health system internal clinical process, not a sales process. While it feels good to be told you are important in the product selection process, and to be wined and dined, it's likely you aren’t prepared for the behind-the-scenes infrastructure that has been built to manage you and your processes.

As many are aware, Physicians, hospitals, and other healthcare companies receive money from medical and pharmaceutical manufacturers. How much money?

In 2018 according to this detailed report, $12B was paid out. The breakdown:1,036,163 Doctors, 1,249 Teaching Hospitals, 2191 companies were paid. In 2023 the amount was up to $12.75B. (Dollars for Docs - ProPublica (Source: The Centers for Medicare and Medicaid Services?Open Payments?data.))

If you take the time to look at the report, you’ll find how much they received, broken down by individual names. Additionally, if you’ll look at Home | OpenPayments (cms.gov), you can look at more current years.

How might this be a Value Analysis issue, and why might there need to be cautious about sales reps' intent? The Value Analysis process includes, but is not limited to the following steps which result in a recommendation for products selection by the Value Analysis Committees for use in patient care:

·???????? Product comparative analysis,

·???????? Accepted peer reviewed clinical literature,

·???????? Physician or hospital studies, and input

·???????? Scientific literature and information received from manufacturers on product studies presented at conferences, or to the FDA for approval of devices or pharmaceuticals, as well as physician experience testimonials

·???????? Patient outcome data,

·???????? Observations of manufacturing methods, materials, and processes, and detailed information from a manufacturers clinical staff

Notice the word “products” is plural in the “recommendations for products selection” statement above. A value analysis process should use good faith intent, unbiased data (where possible), the best ethics and compliance validation, and no conflict-of-interest people or processes to arrive at physician and clinician agreed upon best acceptable standards of quality when working through the process of products selection. The selection should result in two or more products that would move into the process to acquire.

Sales reps have a primary goal of selling products. That’s how they get paid. The more they sell, the more money they make. As it should be providing the playing field is level, there’s transparency in the selling process, and people are held accountable on both sides of the equation for a lack of “good faith”. (I wonder in this process where value analysis professionals are selecting products and determining which products will be acquired and used on patients why they aren’t held to a stringent Open Payments reporting requirement like physicians and other healthcare professionals? Or, why the Sunshine Act doesn't apply to Suppliers with regards to Value Analysis Professionals as it does with Physicians?) One might say Value Analysis Professionals don’t accept money for speaking engagements, participation in studies, literature reviews, or many of the other reasons used to pay physicians. Not yet they don’t! ?When value analysis is validated by sales reps to be a process where sales growth can occur quickly with minimal investment, there will be the same, or similar incentives to offer value analysis professionals as we have seen for years with physicians. $12.75B removes good faith and replaces it with bias. $12.75B is an investment in bias. I leave you with this question. Why are there no independent patient studies either retrospective or prospective that reveal best performance and outcome quality? Here’s the answer: Manufacturers don’t want and won’t allow independent studies to reveal whose product performs best! None of the mainstream manufacturers who “compete” in this space want it. $12.75B guarantees it won’t happen. Why? Who would conduct the studies if patients were fortunate enough to have it occur? Physicians, Health Systems, and Medical Insurance Companies would collectively provide data and resources. While I can’t find evidence of Medical Insurance Companies taking payments from Medical Device or Pharmaceutical Manufacturers, there is plenty of evidence that Physicians and Health Systems do.

Further, if these studies were to occur, they would be the foundation for a new and improved Value Analysis process where real performance and outcome data would be used to make quality and cost product selections with a true value-based care platform. Sales rep and payment interference would have to be outlawed, and should be, as a conflict of interest.

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Interesting Reading:

OIG Warns Healthcare Providers on Speaker Fees Paid by Pharmaceutical, Medical Device Companies | Insights | Holland & Knight (hklaw.com)

Payments to Doctors by Pharmaceutical Companies Raise Issues of Conflicts - The New York Times (nytimes.com)

Medical device firms’ payments to doctors outstrip those from pharma (statnews.com)

We Found Over 700 Doctors Who Were Paid More Than a Million Dollars by Drug and Medical Device Companies — ProPublica

Conflicts of Interest: Relationships with Industry-Medical Device Manufacturers and Pharmaceutical Companies | COSMOS Compliance Universe (compliancecosmos.org)

Lucrative Speaking Engagements with Drug and Medical Device Companies: Approach with Caution - Lexology