Survey Finds Few Orthopedic Surgeons Know The Costs Of The Devices They Implant

Abstract

Orthopedic procedures represent a large expense to the Medicare program, and costs of implantable medical devices account for a large proportion of those procedures’ costs. Physicians have been encouraged to consider costs in the selection of devices, but several factors make acquiring information about costs difficult. To assess physicians’ levels of knowledge about costs, we asked orthopedic attending physicians and residents at seven academic medical centers to estimate the costs of thirteen commonly used orthopedic devices between December 2012 and March 2013. The actual cost of each device was determined at each institution; estimates within 20 percent of the actual cost were considered correct. Among the 503 physicians who completed our survey, attending physicians correctly estimated the cost of the device 21 percent of the time, and residents did so 17 percent of the time. Thirty-six percent of physicians and 75 percent of residents rated their knowledge of device costs “below average” or “poor.” However, more than 80 percent of all respondents indicated that cost should be “moderately,” “very,” or “extremely” important in the device selection process. Surgeons need increased access to information on the relative prices of devices and should be incentivized to participate in cost-containment efforts.

Documentation and investigation of missing health care equipment: The need to safeguard high priced devices in health care institutions

“…While the threshold for defining high cost for a medical device will vary based on geography, setting, and over time, a suggested one for North American hospitals at this time is greater than 5,000 USD. [20] Similar to traditional case reporting on injuries and "near misses" in a hospital setting, reports on missing equipment should be investigated and documented in a non-judgmental and factual fashion. The investigation and report are in no way designed to lay blame, rather, it should aim to understand the systems issues and to determine ways to improve policies and procedures to prevent future occurrences.…”

“…Table 1. Recommendations for the investigation of the loss of costly hospital equipment Recommendation  Prior to implementing new equipment, institutions and organizations should reduce the risk of equipment loss through pre-emptive risk assessments and strategies  Identify a responsible party (person or unit) for investigating and reporting on the loss of medical equipment above an established cost threshold (e.g., greater than $5,000 USD [20] )…”

Accessibility, accountability, affordability: healthcare policy in orthopedic trauma

“…Most orthopedic surgeons do not know the costs of the implants they use [32]. By familiarizing ourselves with less expensive and noninferior implant options, we can become active participants in hospital cost-reduction efforts without compromising patient care.…”

Shelf Pricing for Distal Radius Fracture Implants

“…For the most costly implants, the total implant cost per case accounted almost 100% of the Medicare reimbursement to the facility. As has been reported by others [3], the surgeons using these devices in our practice had little knowledge of the cost differences among the implants they used, and generally chose their implants based on familiarity without cost consideration.…”