AAOS Exclusive: Survey Says Orthopedic Surgeons Don’t Know Cost of Implants

A survey conducted of 503 orthopedic surgeons across multiple U.S. centers has found that most of them have very little knowledge of the true cost of the orthopedic implants they use in patients. As cost of medical care increasingly becomes a concern in the United States, this issue is one that Kanu M. Okike, M.D., and his colleagues who conducted the survey believe is one of utmost importance to address inefficiency of care.

Okike, an orthopedic surgeon and Harvard Medical School graduate practicing at Kaiser Permanente in Honolulu, Hawaii, presented the study on behalf of his colleagues at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans, La. on March 13.

According to the abstract, “implantable medical devices represent a substantial portion of healthcare expenditures, and orthopedic surgeons have been encouraged to participate in the management of scarce resources by considering cost when selecting implants. However, several barriers currently hinder acquisition of implant cost knowledge among surgeons.”

Okike said that some of those obstacles include confidentiality clauses in contracts between vendors and hospitals; pricing that varies per site; and surgeons not having an incentive to minimize cost.

In conducting the survey, 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 only 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.

There are two challenges in reducing obstacles to surgeon knowledge of cost, Okike said:

“First is knowledge, and the second is incentive. To address knowledge—while we can’t post cost of different vendors’ implants on the wall of the operating room (OR) due to confidentiality clauses, we can categorize them into red, yellow and green, according to cost. We have started posting that on OR walls now. The next step is determining whether that’s enough or if there need to be some incentives tied to that.”

Okike and his colleagues took into consideration that some institutions use one brand while others use other brands, so the survey did not address specific brands of products. That would be the next step, Okike said—to assess relative knowledge by brand.

If surgeons evidently do not select implants by price, other than quality, what factors do they use in implant selection?

“A lot of the time it’s familiarity—so if they used one brand in their training, they will be likely to select that brand again,” Okike told Orthopedic Design & Technology. “Sales representatives in the area, hospital deals, and what’s available on the shelf will also have an effect. In the future, surgeons are going to take cost into consideration more, especially as incentives are introduced.”

To read the full abstract of the survey, click here.