What Does it Take to Get Their Attention?
This week, the Advisory Committee on Blood and Tissue Safety and Availability (ACBTSA) met to consider the RAND report on the sustainability of the blood supply. The committee made critical comments and recommendations to the Assistant Secretary for Health, whose office funded the report. ACBTSA established blood is explicitly seen as a public good and we hope rational policy decisions regarding the blood supply system will be forthcoming from the incoming administration.
The report itself is disappointing. This was clearly stated in our comments to the committee and reflected in the ACBTSA subcommittee presentation. Most crucially, the report does not convey the sense of urgency that many of us feel about the system's sustainability. We have appropriately reduced collections to respond to the decline in demand and competition has further reduced our margins. More than half of the nation's blood supply is now being collected by organizations operating at negative margins. Capacity beyond the immediate needs is not available. The committee discussed the declining ability to respond to a surge in demand, such as might occur in a disaster, and the need for a resilient supply to cover day-to-day variations. Collection figures this fall suggest reserves going into the holidays may not be robust, and challenges may lie ahead. However, RAND did not properly recognize nor make any recommendations regarding the "insurance value of blood" and did not use available financial data. This year, the U.S. supplied Puerto Rico's needs until they could address Zika, we are absorbing the impact of the donor final rule, and have emergently implemented mandated Zika testing, all without any significant infusion of "new money" while RAND really limited their conclusions to the apparent absence of widespread shortages that would require urgent action.
We are victims of our own excellent performance and are setting ourselves up for failure. If we only address the issue of crisis after it has occurred, patients will bear the consequences. Other payment approaches need to be developed that recognize the "public good" of the blood supply (think public utilities).
Yet, this has not been a worthless exercise. We in the blood community have come together to discuss this issue. It is eminently clear that we need better DATA to clarify the situation. We cannot rely on global surveys, like the National Blood Collection and Utilization Survey, which produce aggregate, but almost two-year-old data, without sufficiently graphic evidence of bad outcomes to impress RAND. We need a system to supply and demand with more granularity, with local effects, and a real definition of shortages so we will know what the scope of the problem is. Of course, it will be difficult to develop systems without new money.