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COrganizations Providing Background Infonnation The following 14 organizations include academic institutions, govem- ment agencies, health care product manufacturers, health care provider organizations, and ~ird-parLy payers that provided information about potential topics for assessment and/or the enters Hey use in setting their own assessment pnorities. AMERICAN COLLEGE OF PHYSICIANS (ACP) The ACP is a national society of internists and related medical subspe- cialists that works to uphold health care standards Trough its activities in continuing medical education, health policy analysis, quality assurance, and medical technology assessment The Clinucal Efficacy Assessment Project (CEAP) conducts assessments to provide physicians with current infonnation and guidelines regarding the use of tests, procedures, and therapies and with the rationale for such recommendations founded bow on literature reviews and broad-based expert opinion. ACP provided a list of priority clinical conditions and technologies Hat were assessment priorities for CEAP as of March 1989 (Amencan College of Physicians, 1989~. 83

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84 AMERICAN HOSPITAL ASSOCIATION (AMA) NATIONAL A-SSESSMENTPRlORmES The AHA is a trade association that represents member hospitals and provides advocacy, policy development, and other data and support serv- ices. Its Hospital Technology Series Program provides publications to assist hospital administrators in making prudent and informed decisions regarding new and existing medical technologies. The Division of CTini- cal SeIvices and Technology (CST) produces Medtitrends, an annual publication that describes current trends and developments in medical technologies of interest to those involved in the strategic planning and management of clinical services (American Hospital Association, 19891. The 1989 edition of Meditrer~s was a source for identifying candidate medical technologies for this project. AMERICAN MEDICAL ASSOCIATION (AMA) The AMA is a professional association that provides a wide range of services and products to advance the field of medicine. The Diagnostic and Therapeutic Technology Assessment (DACHA) program was estab- lished to provide accurate, balanced, and up-to-date infonnation on medi- cal technology to the practicing medical community, and to communicate the concerns and opinions of physicians to other constituents of the health care community. The topics of medical technology assessments con- ducted by the DATTA as of May 1989 (Amencan Medical Association, 1988-89) were reviewed for this project. BLUE CROSS AND BLUE SHIELD ASSOCIATION (BCBS) The BOBS represents member Blue Cross and Blue Shield plans and advises them on health care insurance issues. As a trade association it provides its member plans with medical, financial, and administrative consultations and technical assistance. A list of medical technologies and modalities that served ~ illustrate He BCBS's immediate assessment needs as of March 1989 was reviewed for this project (Blue Cross and Blue Shield Association, 1989a). Also reviewed was a list of some of the surgical procedures (expressed in CPI-4 codes) associated with the most expenditures for He BCBS Federal Employees Program dunng calendar years 1987 and 1988. Inscitudonal expenditures and related professional expenditures for such services as anesthesia, pathology, radiology, or others were not included in this lisdng (Blue Cross and Blue Shield Association, 1989b).

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APPENDIX C ECRI 85 ECRI, formerly the Emergency Care Research Institute, is an inde- pendent not-for-profit corporation that provides judgment for the selec- tion, purchase, and use of medical instruments, equipment, and systems; functions as a cleannghouse for investigating and resolving hazards and deficiencies in medical devices; and encourages the ~rnprovement of medical devices through an info'~ed marketplace. "New Equipment for 1989 Capital Budgets" and 'technology Opportunities for He 1990s: A Checklist for Hospital Strategic Technology Planning," annual ECRI articles (published in Health Technology) that present a range of new and emerging medical technologies that hospitals might consider purchasing, were used as a resource for this project (ECRI, 198S, 1989e). HEWLETT-PACKARD COMPANY Hewlett-Packard Company is an international manufacturer of meas- urement and computation products and systems win revenues of $9.8 billion in fiscal year 1988. The company's products are used In industry, business, eng~neenng, science, medicine, and education in more man 93 countries. The Medical Products Groups offers more than 350 major medical products and systems and over 400 medical supplies for applica- tions throughout He hospital and in physician's offices, surgical centers, laboratories, emergency care centers, health maintenance org~za- i~ons, and altemate-care facilities. Primary markets for the company medical products are cardiology, cntical-care, surgery, obstetncs, and administration. Hewlett-Packard provided a set of clinical conditions it considered to be 0th anon (Hewlett-Packard Company, 1989~. INSTITUTE FOR HEALTH POLICY ANALYSIS aHPA), GEORGETOWN UNIVERSITY The Institute for Health Policy Analysis, a not-for-profit research insti- tute, conducts research on and analyzes important national health policy issues. The Technology and Health Care Program was established to improve He public's understanding of national health policy issues and to aid He process by which policy is set within He govemment. SPA provided a list of pnonty-setting criteria developed by He Panel for the Appropriate Use of Technology convened by IHPA in December 1988 (Institute of Heals Policy Analysis, Georgetown University, 1989~.

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86 NATIONAL `4S5=SM~VTPRIORmES INSTITUTE OF MEDICINE COMMITTEE ON THE El ~ ACTIVENESS INITIATIVE OF THE HEALTH CARE FINANCING ADMINISTRATION (IOM/HCFA) In 198S, ache Health Care Financing A~nin~stradon (HCFA) of the U.S. Department of Heady and Human Services, which is responsible for administering the Medicare program, proposed an Effectiveness Lnitiadve to use He resources of the Medicare program to abbess the question of what works In the practice of medicine. During this time, HCFA re- quested the Institute of Medicine to recommend clinical conditions that should receive priority attention at He outset of He agency's proposed Effectiveness Initiative (Institute of Medicine, 1989~. The priority cI~ru- cal conditions recommended to HCFA by the Institute of Medicine com- mittee established for Hat purpose were considered for this project. METROPOLITAN LIFE INSURANCE COMPANY Metropolitan Life and its affiliated companies provide a broad range of insurance, investment, financing, real estate, and related products and services. Metropolitan Life and affiliates insure or administer coverage for 42 minion people in the United States, Canada, and other countries. A list of He most frequent outpatient procedures (expressed in CPI-4 codes) paid by Metropolitan Life in 1988 was reviewed for this project (Metro- politan Life Insurance Company, 1989~. OFFICE OF HEALTH TECHNOLOGY ASSESSMENT (OHTA), NATIONAL CENTER FOR HEALTH SERVICES RESEARCH The National Center for Health Services Research and Heals Care Technology Assessmera is a major source of federal support for research to evaluate health services, assess technologies, and improve access to new scientific and technical information for research users. The OHTA has direct responsibility for assessing technologies for the Public Heals Service In response to Quests from federally funded programs such as the Heal Cate Financing A~nin~stration. A list of the technologies pending assessment In OHTA as of March 1989 was provided by the agency (National Center for Health Services Research, 1989~.

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APPENDIX C 87 OFFICE OF MEDICAL APPLICATIONS OF RESEARCH (OMAR), NATIONAL INSTITUTES OF HEALTH (NIH) The OMAR of NIH has a number of activities related ~ medical applications of research, technology transfer, and technology assessment. Among these, OMAR operates the NTH Consensus Development Pro- gram. The purpose of this program is to evaluate in a public forum the use of biomedical technologies, to publish a consensus statement relevant to the public at large that provides guidelines for practitioners on the use of the technology, and to disseminate this information to the intended audi- ence. For this project OMAR provided a list of the planned and possible topics for upcoming consensus development conferences and workshops (Office of Medical Applications of Research, 19891. OFFICE OF TECHNOLOGY ASSESSMENT (OTA), U.S. CONGRESS The OTA is an analytical support agency that selves the U.S. Congress. The activities within the OTA Health Progr~n are aimed at helping Congress anticipate and plan for the consequences of technological appli- cations and at examining the ways, both expected and unexpected, in which medical technology affects individual lives. OTA provided a set of recommended high-pnonty clinical conditions and technologies (Office of Technology Assessment, 1989~. PFIZER, INC. Pfizer, Inc., is a research-based company win an emphasis on health care and sales of $5.4 billion In 1988. Operating in 140 countries, it develops, manufactures, and martinets innovative products in five business segments: health care (proprietary pharmaceutical and medical devices); agnculture (animal health products); specialty chemicals (intermediates for pharmaceutical and animal health products and ingredients for food and beverage industries); consumer Nonprescription health care products and cosmetics and fragrances); and matenals science (miner~-based prod- ucts, magnetic oxides, and pigments for industrial uses). Pfizer provided a set of recommended high-prionty clinical conditions for which physi- cians have to select Snug therapies among multiple technologies (Pfizer, Inc., 1989~.

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88 HA77ONAL ASSESSMENTPRlORmE:S PROSPECTIVE PAYMENT ASSESSMENT COMMISSION (ProPAC) ProPAC is an independent advisory body mat recommends to U.S. Congress and the Secretary of Health and Human Services an appropriate percentage change in the payments made under the Medicare prospective payment system (PPS) for inpatient hospital services and recommends adjustments to He diagnosis-related group (DRG) classification and weigh- ing factors. In 1988 Project HOPE conducted a study for ProPAC to estimate the cost impact of important new medical technologies affecting Medicare in fiscal year 1989 (Project HOPE, 1988~. The list of new tech- nologies identified by Project HOPE was incorporated into the composite list of potential assessment topics considered in this report.