Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 6/2013

01-06-2013 | Symposium: Aligning Physician and Hospital Incentives

Healthcare Technology: Physician Collaboration in Reducing the Surgical Cost

Authors: Steven A. Olson, MD, William T. Obremskey, MD, MPH, Kevin J. Bozic, MD, MBA

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2013

Login to get access

Abstract

Background

The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care.

Questions/purposes

The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology.

Methods

We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making.

Results

Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances.

Conclusions

Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.
Appendix
Available only for authorised users
Literature
1.
go back to reference Bozic KJ. Value-based healthcare and orthopaedic surgery. Clin Orthop Relat Res. 2012;470:1004–1005.PubMedCrossRef Bozic KJ. Value-based healthcare and orthopaedic surgery. Clin Orthop Relat Res. 2012;470:1004–1005.PubMedCrossRef
2.
go back to reference Bozic KJ, Roche M, Agnew SG. Hospital-based employment of orthopaedic surgeons—passing trend or new paradigm? AOA critical issues. J Bone Joint Surg Am. 2012;94:e59.PubMedCrossRef Bozic KJ, Roche M, Agnew SG. Hospital-based employment of orthopaedic surgeons—passing trend or new paradigm? AOA critical issues. J Bone Joint Surg Am. 2012;94:e59.PubMedCrossRef
3.
go back to reference Briggs A, Sculpher M, Britton A, Murray D, Fitzpatrick R. The costs and benefits of primary total hip replacement. How likely are new prostheses to be cost-effective? Int J Technol Assess Health Care. 1998;14:743–761.PubMedCrossRef Briggs A, Sculpher M, Britton A, Murray D, Fitzpatrick R. The costs and benefits of primary total hip replacement. How likely are new prostheses to be cost-effective? Int J Technol Assess Health Care. 1998;14:743–761.PubMedCrossRef
4.
go back to reference Campillo-Artero C. When health technologies do not reach their effectiveness potential: a health service research perspective. Health Policy. 2012;104:92–98.PubMedCrossRef Campillo-Artero C. When health technologies do not reach their effectiveness potential: a health service research perspective. Health Policy. 2012;104:92–98.PubMedCrossRef
5.
go back to reference Chandra C, Kumar S, Ghildayal NS. Hospital cost structure in the USA: what’s behind the costs? A business case. Int J Health Care Qual Assur. 2011;24:314–328.PubMedCrossRef Chandra C, Kumar S, Ghildayal NS. Hospital cost structure in the USA: what’s behind the costs? A business case. Int J Health Care Qual Assur. 2011;24:314–328.PubMedCrossRef
6.
go back to reference Chang RW, Pellisier JM, Hazen GB. A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA. 1996;275:858–865.PubMedCrossRef Chang RW, Pellisier JM, Hazen GB. A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA. 1996;275:858–865.PubMedCrossRef
7.
go back to reference Eisenberg JM. Do better outcomes mean better quality care? Trans Am Clin Climatol Assoc. 1999;110:15–20; discussion 20–22.PubMed Eisenberg JM. Do better outcomes mean better quality care? Trans Am Clin Climatol Assoc. 1999;110:15–20; discussion 20–22.PubMed
8.
9.
go back to reference Fine A. Developing an assessment process for new technologies. Healthc Financ Manage. 2003;57:84–87.PubMed Fine A. Developing an assessment process for new technologies. Healthc Financ Manage. 2003;57:84–87.PubMed
10.
go back to reference Gelberman RH, Samson D, Mirza SK, Callaghan JJ, Pellegrini VD Jr. Orthopaedic surgeons and the medical device industry: the threat to scientific integrity and the public trust. J Bone Joint Surg Am. 2010;92:765–777.PubMedCrossRef Gelberman RH, Samson D, Mirza SK, Callaghan JJ, Pellegrini VD Jr. Orthopaedic surgeons and the medical device industry: the threat to scientific integrity and the public trust. J Bone Joint Surg Am. 2010;92:765–777.PubMedCrossRef
11.
go back to reference Goetghebeur MM, Forrest S, Hay JW. Understanding the underlying drivers of inpatient cost growth: a literature review. Am J Manag Care. 2003;9:SP3–12.PubMed Goetghebeur MM, Forrest S, Hay JW. Understanding the underlying drivers of inpatient cost growth: a literature review. Am J Manag Care. 2003;9:SP3–12.PubMed
12.
go back to reference Gooch KL, Smith D, Wasylak T, Faris PD, Marshall DA, Khong H, Hibbert JE, Parker RD, Zernicke RF, Beaupre L, Pearce T, Johnston DW, Frank CB. The Alberta Hip and Knee Replacement Project: a model for health technology assessment based on comparative effectiveness of clinical pathways. Int J Technol Assess Health Care. 2009;25:113–123.PubMedCrossRef Gooch KL, Smith D, Wasylak T, Faris PD, Marshall DA, Khong H, Hibbert JE, Parker RD, Zernicke RF, Beaupre L, Pearce T, Johnston DW, Frank CB. The Alberta Hip and Knee Replacement Project: a model for health technology assessment based on comparative effectiveness of clinical pathways. Int J Technol Assess Health Care. 2009;25:113–123.PubMedCrossRef
13.
go back to reference Gordon GJ, Tan KM. Technology assessment and equipment planning in Kaiser Permanente, Northern California Region. J Clin Eng. 1992;17:209–213.PubMed Gordon GJ, Tan KM. Technology assessment and equipment planning in Kaiser Permanente, Northern California Region. J Clin Eng. 1992;17:209–213.PubMed
14.
go back to reference Goyen M, Debatin JF. Healthcare costs for new technologies. Eur J Nucl Med Mol Imaging. 2009;36(Suppl 1):S139–143.PubMedCrossRef Goyen M, Debatin JF. Healthcare costs for new technologies. Eur J Nucl Med Mol Imaging. 2009;36(Suppl 1):S139–143.PubMedCrossRef
15.
go back to reference Gutowski C, Maa J, Hoo KS, Bozic KJ. Health technology assessment at the University of California-San Francisco. J Healthc Manag. 2011;56:15–29; discussion 29–30.PubMed Gutowski C, Maa J, Hoo KS, Bozic KJ. Health technology assessment at the University of California-San Francisco. J Healthc Manag. 2011;56:15–29; discussion 29–30.PubMed
16.
go back to reference Johnson DE. Will disruptive innovations cure health care? Harv Bus Rev. 2000;78:197–198.PubMed Johnson DE. Will disruptive innovations cure health care? Harv Bus Rev. 2000;78:197–198.PubMed
17.
go back to reference Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89:46–52, 54, 56–61 passim. Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89:46–52, 54, 56–61 passim.
18.
go back to reference Lansky D, Nwachukwu BU, Bozic KJ. Using financial incentives to improve value in orthopaedics. Clin Orthop Relat Res. 2012;470:1027–1037.PubMedCrossRef Lansky D, Nwachukwu BU, Bozic KJ. Using financial incentives to improve value in orthopaedics. Clin Orthop Relat Res. 2012;470:1027–1037.PubMedCrossRef
19.
go back to reference Luft HS, Garnick DW, Hughes RG, Hunt SS, McPhee SJ, Robinson JC. Hospital competition, cost, and medical practice. J Med Pract Manage. 1988;4:10–15.PubMed Luft HS, Garnick DW, Hughes RG, Hunt SS, McPhee SJ, Robinson JC. Hospital competition, cost, and medical practice. J Med Pract Manage. 1988;4:10–15.PubMed
20.
go back to reference McGrady E, Conger S, Blanke S, Landry BJ. Emerging technologies in healthcare: navigating risks, evaluating rewards. J Healthc Manag. 2010;55:353–364; discussion 364–365.PubMed McGrady E, Conger S, Blanke S, Landry BJ. Emerging technologies in healthcare: navigating risks, evaluating rewards. J Healthc Manag. 2010;55:353–364; discussion 364–365.PubMed
21.
go back to reference O’Shea K, Bale E, Murray P. Cost analysis of primary total hip replacement. Ir Med J. 2002;95:177–180.PubMed O’Shea K, Bale E, Murray P. Cost analysis of primary total hip replacement. Ir Med J. 2002;95:177–180.PubMed
22.
go back to reference Salk J. Immunization against poliomyelitis: risk/benefit/cost in a changing context. Dev Biol Stand. 1979;43:151–157.PubMed Salk J. Immunization against poliomyelitis: risk/benefit/cost in a changing context. Dev Biol Stand. 1979;43:151–157.PubMed
23.
go back to reference Turnipseed WD, Lund DP, Sollenberger D. Product line development: a strategy for clinical success in academic centers. Ann Surg. 2007;246:585–590; discussion 590–592.PubMedCrossRef Turnipseed WD, Lund DP, Sollenberger D. Product line development: a strategy for clinical success in academic centers. Ann Surg. 2007;246:585–590; discussion 590–592.PubMedCrossRef
24.
go back to reference Zuckerman JD, Kummer FJ, Frankel VH. The effectiveness of a hospital-based strategy to reduce the cost of total joint implants. J Bone Joint Surg Am. 1994;76:807–811.PubMed Zuckerman JD, Kummer FJ, Frankel VH. The effectiveness of a hospital-based strategy to reduce the cost of total joint implants. J Bone Joint Surg Am. 1994;76:807–811.PubMed
Metadata
Title
Healthcare Technology: Physician Collaboration in Reducing the Surgical Cost
Authors
Steven A. Olson, MD
William T. Obremskey, MD, MPH
Kevin J. Bozic, MD, MBA
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 6/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-2828-7

Other articles of this Issue 6/2013

Clinical Orthopaedics and Related Research® 6/2013 Go to the issue