Case Study: The Feasibility of BEAM

Brain electrical activity mapping (BEAM) is a technology for imaging the brain. It significantly improves the physician's ability to localize an abnormality. In response to increased demands for this procedure from staff radiologists and local neurologists and reports in the literature of the usefulness of BEAM testing, Metropolitan Hospital has decided to investigate the possibility of acquiring access to BEAM testing. Two options are to lease and to purchase. A third option is to ask nearby County Hospital to share its recently acquired BEAM machine.

A major unknown is uncertainty about the future of reimbursement. It is likely that Medicare DRG payments will be reduced. In addition, other third-party payers are requiring more stringent review of new technologies. Because of the reimbursement issues and major expenditures involved, the governing body chair asked the CEO to form a committee and evaluate each option, including foregoing access to BEAM testing. The assessment will permit a final decision between BEAM and a proposed addition to the intensive care unit, a project that is supported strongly by the surgical staff and that has already been delayed twice.

The governing body would prefer to delay this decision until reimbursement is better understood, but several attending physicians think that BEAM testing is critical to their practices and have stated that, although they prefer the nursing staff at Metropolitan, quality of care considerations will force them to admit certain patients to County so they can have access to BEAM. Recently, you were told about a rumor that several prominent physicians want to develop a consortium to purchase and operate BEAM and other diagnostic equipment in a professional office complex that is under construction.

QUESTIONS

1. Propose the membership of a committee to assess the need for BEAM and, if it is to be made available at Metropolitan, to recommend whether to buy, lease, or use County's BEAM.

2. What types of information should be presented to the governing body in the committee's final report?

3. What political and economic complications are likely to be present in the decision-making process?

4. How should the political and economic complications be addressed? Be specific in identifying the sequence of steps.