Posted on August 13, 2026 by Sunny Singh
If you have been selling medical devices for more than a few years, you remember the old playbook. Find the surgeon. Build the relationship. Get the product into the OR. The surgeon’s word was close to law when it came to what the hospital bought, and a good rep with a strong physician champion could move mountains.
That world is mostly gone.
Today, nearly every U.S. hospital runs new product decisions through a value analysis committee (VAC). A VAC is a cross-functional body within a hospital or health system that evaluates whether a new medical device, supply, or piece of capital equipment should be approved for use. It is the formal gatekeeping function that sits upstream of procurement and contract negotiation.
For medtech companies, the VAC has become the single most consequential gate between a cleared product and actual revenue. Win the VAC, and you open the door to an entire facility or health system. Lose, and you are locked out for 12 to 24 months until the next review cycle. Show up unprepared, and you don’t just lose the deal. You burn your credibility with committee members who will remember you the next time you come back.
Yet, most medtech companies still approach value analysis as they did hospital selling a decade ago. They lead with features, lean on the physician relationship, and hope the clinical story carries the day.
It doesn’t carry the day anymore. Here is what has actually changed, and what VACs are looking for now.
The first mistake most medtech companies make is conceptual. They treat the value analysis committee like a procurement conversation. They show up with pricing sheets, volume discounts, and GPO contract references. They prepare as if the question on the table is “how much does this cost?”
The real question is different. It is whether the product should be approved for use in the institution at all.
A VAC evaluates clinical value, financial impact, safety, and operational fit. Only after the committee votes to approve a product does it move downstream to contract negotiation with supply chain and, if applicable, GPO channel procurement. This distinction matters because it changes what you bring to the table. A purchasing conversation is about price, terms, and volume commitments. A value analysis conversation is about evidence, outcomes, total cost of ownership, and whether your product solves a problem the institution actually has.
According to research published in the Value in Health Journal, 64% of hospitals were using some form of value analysis committee by 2012. That number has climbed steadily since. The same research found that medical device companies who understood the evidence requirements and committee composition had significantly better outcomes than those who treated the VAC as an extension of the traditional sales call.
Companies that confuse the two end up pitching financial proposals to a committee that wants clinical evidence. Or they rattle off product features to a room that needs a total cost of ownership model. Both are losing strategies.
And yet, the majority of medtech companies still approach value analysis the way they approached hospital selling a decade ago. They lead with features, lean on the physician relationship, and hope the clinical story carries the day. However, Why Clinician Enthusiasm Does Not Close Hospital Deals is a reminder that enthusiasm alone isn’t enough to make the sale.
The composition of a value analysis committee tells you everything about how the hospital thinks about purchasing decisions. These committees are deliberately cross-functional, and each constituency evaluates your product through a different lens.
A decade ago, a strong clinical champion and a compelling product demo could carry a VAC decision. Today, the evidence requirements have ratcheted up to a level that would have been unrecognizable to the medtech sales teams of 2015.
VACs now expect peer-reviewed clinical studies, ideally randomized controlled trials, but at minimum well-designed prospective studies published in credible journals. They expect comparative data: not just “our product works,” but “our product reduces complications by X% relative to the current standard of care.” They expect real-world evidence from institutions comparable to theirs in patient population, case volume, and acuity level.
This shift was driven by several forces converging at once.
Hospital operating margins have been under sustained pressure. The American Hospital Association’s 2025 Cost of Caring report documented rising supply costs, labor inflation, and reimbursement that has not kept pace. When margins are thin, every purchasing decision faces more scrutiny, and “the surgeon wants it” is no longer a sufficient justification for adding cost.
The rise of value-based care models ties into these challenges, further pressuring hospitals to demonstrate that new products offer measurable improvements to patient outcomes, not just additional costs.
If the evidence bar catches some companies off guard, the financial case is where most of them actually lose. Generic ROI calculators with national average assumptions don’t persuade a committee that reviews dozens of vendor pitches per year. What works is a financial case built on data specific enough to the hospital’s situation that the committee trusts the numbers.
This means starting with the hospital’s current costs in the product category you are addressing. CMS cost reports provide departmental spending data for Medicare-certified hospitals. Combined with publicly available case volume data, you can build a reasonable baseline estimate even before your clinical champion shares internal numbers.
From that baseline, the financial case needs to address total cost of ownership. That includes unit cost multiplied by projected annual volume, implementation and training costs, inventory carrying costs, service and maintenance costs for capital equipment, and any revenue or reimbursement impact.
Research published by the Association for Health Care Resource and Materials Management (AHRMM) estimates that physician-preferred items account for 40-60% of a hospital’s total supply costs. That spending concentration is precisely why VACs exist: to impose discipline on purchasing decisions that were historically driven by individual physician preference rather than institutional cost-benefit analysis.
A product that costs 10% more per unit but demonstrably reduces complications and therefore readmissions (which CMS penalizes through its Hospital Readmissions Reduction Program) can have a net positive financial impact. But you have to build that story with actual numbers, not hand-waving.
The clinical champion inside the hospital remains the single most important factor in a VAC outcome. No vendor wins a value analysis approval alone. The champion submits the product request, presents the case to the committee, answers clinical questions from peers, and advocates during deliberation, which happens behind closed doors, without the vendor present.
But the champion dynamic has shifted in important ways.
In the old model, any surgeon with volume and influence could push a product through. Today, the ideal champion combines clinical credibility (the committee respects their judgment), direct experience with your product (they have used it during training, at a previous institution, or in a trial), and enough institutional influence to carry a vote. Department chairs and medical directors are obvious candidates, but a well-respected mid-career clinician who consistently participates in committees can be equally effective.
Several forces outside the hospital’s walls are changing what VACs prioritize and how quickly they move.
Health system consolidation has concentrated purchasing power in ways that raise the stakes of every VAC decision. According to Definitive Healthcare, approximately 75% of U.S. hospitals now belong to a health system or integrated delivery network. The top 100 health systems control more than a third of total hospital spending on devices and supplies. Winning a VAC approval at the system level can mean access to 20, 50, or even 200 facilities on a single decision. Losing one can eliminate a territory overnight.
Tariff pressures and supply chain uncertainty are creating new budget anxiety. A TD Securities survey of 20 U.S. hospital executives found that 75% reported macro factors were impacting planned capital purchases, with 40% planning to cut or defer capital equipment spending. The American Hospital Association reported that 82% of healthcare experts expect tariff-related expenses to raise hospital costs by at least 15%, and 94% of administrators expected to delay equipment upgrades. When hospitals tighten their belts, VACs become more conservative. Products that can demonstrate clear, near-term financial return have an advantage over those requiring a leap-of-faith investment with a long payback horizon.
The shift toward ambulatory surgery centers is opening a parallel buying channel with fundamentally different dynamics. CMS added more than 500 procedures to the ASC-eligible list in its 2026 final rule. ASCs typically feature physician-owners or smaller administrative teams as decision-makers rather than centralized procurement committees. The VAC process may be lighter or absent entirely. But the value proposition has to be different: compatible with streamlined workflows, predictable scheduling, and faster patient turnover.
Moreover, many medtech companies experience growth stalls after early traction. The same issue arises when hospitals delay purchases or demand better evidence for product efficacy. In fact, Why Medtech Growth Stalls After Early Traction discusses why some medtech companies fail to scale, even when they initially succeed in securing some contracts.
If you are a medtech CEO or commercial leader reading this, the implications are concrete.
The VAC is not an obstacle to navigate around. It is the way hospitals buy now. The companies that succeed are the ones who understand what the committee actually evaluates, prepare accordingly, and bring a case built on evidence rather than enthusiasm.
That bar is higher than it used to be. But for companies willing to clear it, the reward (system-wide adoption, durable account relationships, and a competitive position that is genuinely hard to displace) is worth every hour of preparation.
A value analysis committee (VAC) is a cross-functional body within a hospital or health system that evaluates whether a new medical device, supply, or piece of capital equipment should be approved for use. It typically includes representatives from supply chain, clinical leadership, physicians, finance, and quality/risk management. The VAC is not a purchasing committee. It decides whether a product should be approved for use before procurement begins contract negotiation.
VACs expect peer-reviewed clinical studies (ideally randomized controlled trials), comparative effectiveness data against the current standard of care, FDA clearance documentation, a total cost of ownership analysis, and real-world outcomes data from comparable institutions. Generic ROI calculators with national averages are generally insufficient. The committee looks for evidence specific enough to their institution’s patient population, case volumes, and financial situation.
The VAC process typically takes three to six months from initial submission to final decision, though it can take longer if the committee requests additional clinical data or a product trial period. VACs meet on a set schedule (monthly or quarterly), and submissions that are incomplete at the preliminary review stage get sent back, which can add months to the timeline.
The most common mistakes are treating the VAC like a purchasing meeting, focusing on features and benefits rather than evidence and comparative effectiveness, not building a total cost of ownership model, and failing to secure a credible internal clinical champion. According to industry practitioners, vendors who present financial projections showing immediate savings without acknowledging implementation costs lose credibility with committee members.
Total cost of ownership (TCO) in the hospital medical device context is the full financial picture beyond unit price. It includes unit cost multiplied by projected annual volume, implementation and training costs, inventory carrying costs, service and maintenance expenses for capital equipment, and any revenue or reimbursement impact (such as reduced readmission penalties under CMS programs). Finance representatives on VACs evaluate TCO, not purchase price.
Most U.S. hospitals use a multi-step process. A clinician (usually a physician or department head) submits a product request to the value analysis committee. The VAC conducts a preliminary review, may approve a clinical trial period, then votes on whether to approve the product. Only after VAC approval does the product move to contract negotiation with supply chain and GPO channel procurement. According to the Healthcare Supply Chain Association (HSCA), approximately 97% of U.S. hospitals are affiliated with at least one group purchasing organization, which often serves as the starting point for pricing and contract terms.
The clinical champion is the physician or senior clinician inside the hospital who submits the product request to the VAC, presents the case to the committee, and advocates for approval during deliberation. No vendor wins a VAC approval alone. The ideal champion has clinical credibility within the institution, direct experience with the product, and enough institutional influence to carry a vote. The vendor’s job is to arm the champion with evidence, financial models, and peer benchmarking data.
According to Definitive Healthcare, approximately 75% of U.S. hospitals now belong to a health system or integrated delivery network, and the top 100 health systems control more than a third of total hospital spending on devices and supplies. This consolidation means a single VAC decision at the system level can grant or deny access to dozens or hundreds of facilities. Sales processes are more complex, involving system-level supply chain leadership, multiple clinical stakeholders, and alignment with centralized GPO contracts.
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