Washington State Health Technology Assessments for Cochlear Implantation and Treatment of Obstructive Sleep Apnea

In recent socioeconomic advocacy efforts, the Academy has been involved in advocating for members by providing comments to the Washington State Health Care Authority (Washington State HCA) regarding the Health Technology Assessments (HTAs) that will likely affect payer policies for reimbursement of services rendered by otolaryngologist-head and neck surgeons. Generally, the Washington State HCA Health Technology Assessments are performed by researchers who have a clinical background and/or are trained in various research methods. This potentially involves clinical trials, case studies, published research, and various other materials. While some assessments are conducted for new technologies, two of the Washington state technology assessments on existing technologies include cochlear implantation and treatment of obstructive sleep apnea. Although the Academy does not get involved in all issues at the state level, the Physician Payment Policy (3P) workgroup reviewed these issues and determined that the outcome at the state level may affect physicians in other states, as many other state agencies and payers look to HTAs when setting policies. Each assessment traditionally results in a conclusion or rating about whether there is sufficient scientific evidence demonstrating that the health technology is safe, works as intended, and is cost effective. Washington State HCA generally follows a five-step process when performing HTAs (http://www.hta.hca.wa.gov/tech_process.html): The Washington State HCA accepts nominations for existing or new technologies for review, and once or twice a year the nominated technologies are prioritized with roughly 10 selected for review. For the selected technologies, the Washington State HCA identifies questions and publishes draft and final key questions on its website. Submitted comments and supporting literature are reviewed by a contracted research firm. Subsequently, a draft and final technology assessment report are produced. Quarterly public meetings are organized by a committee of 11 local clinicians to determine under what circumstances state agencies should pay for the technology. The draft and final coverage decisions are published online. In late December 2011, a fellow member of the Cochlear Coalition contacted the Academy. Subsequently, the Academy’s Implantable Hearing Devices Committee, chaired by Jeffrey J. Kuhn, MD, drafted comments responding to eight different criteria of focus including the following: appropriate population for unilateral versus bilateral cochlear implantation, effectiveness on clinical conditions, and quality of life, diagnosis methods, value statement, alternative treatments, clinical outcomes based on peer-reviewed evidence, cost effectiveness/cost utility, and safety. The responses centered on the relevant criteria and were substantiated by numerous literature sources. Many thanks to Dr. Kuhn and members of the Implantable Hearing Devices Committee who took the time and effort to provide the comprehensive comments on behalf of Academy members. The Academy anticipates the Washington State HCA will publish key questions online soon and will continue to track their interpretation of Academy comments and keep members apprised of updates on the issue. The Academy also has been involved in Washington State HCA’s recent review of the efficacy, effectiveness, and safety regarding various treatments for obstructive sleep apnea (OSA), including continuous positive airway pressure (CPAP), uvulopalatopharyngoplasty (UPPP), radiofrequency ablation, jaw surgery, and bariatric surgery. While Academy staff was notified of this review relatively late in the process (Final Report had been published February 15), staff reached out to Edward M. Weaver, MD, MPH, in Washington state, who attended the Health Technology Clinical Committee (HTCC) meeting on March 16 on behalf of the Academy. We greatly appreciate Dr. Weaver taking the time to attend the meeting. As a result of his attendance and testimony, the Committee recommendations mostly followed the Medicare National Coverage Decisions (for sleep testing and CPAP) and the Local Coverage Determinations (for additional CPAP criteria, mandibular advancement device, and surgery) for the region (four states). Once the coverage decision for OSA HTA is finalized, it will be the OSA diagnosis and treatment policy for Washington state agencies, which include Medicaid, public employees (a large group, and includes public university employees), and others with far fewer sleep apnea patients. For those of you in Washington State, it is quite important and it could influence otolaryngology-head and neck surgeons in other states when those state agencies and payers look to technology assessments, including Washington State HCA, to determine their policies. There is still another step or two in the process (draft and final publishing of the coverage decision), and the Academy will stay on top of that process through Dr. Weaver with any updated information. For more on the Washington State HCA’s process and updated publications, visit their website at http://www.hta.hca.wa.gov/.