Becker's Spine Review

30 Thought Leadership Othopedic implant purchase: 6 surgeon predictions By Laura Dyrda B oth hospitals and ASCs are refining orthopedic implant pur- chasing processes aer the pandemic placed financial pressure on healthcare organizations last year. e move to a more value-based healthcare system also increases scrutiny on the high-cost items, such as instruments and implants. Orthopedic surgeons are already seeing their institutions update vendor contracts and policies. Many hospitals and ASCs are forging exclusive contracts limiting physician choice on the implant systems and technology they use. Organizations are also bringing surgeons into the decision-mak- ing process on a regular basis when signing new vendor contracts. What does the future hold? Six orthopedic surgeons predicted what im- plant purchasing will look like in the coming years. omas Myers, MD. University of Rochester (N.Y.): Regardless of the strategy, I think hospitals are going to take a more aggressive approach to [vendor partnerships]. Other factors like rebates, access to vendor technology such as robots or augmented reality, or 'guarantees' are likely to become more common. ere's a little bit of a 'race to the bottom' on implant margins, which is insulated in part by surgeons who resist adopting equipment they aren't familiar with or perceive to be inferior. Some of this [perceived inferiority] is real, some of it is not. Each hos- pital will have to decide to what degree they will incentivize surgeons to adopt equipment they don't want to use. is will be easier for some surgeon-hospital relationships than others. Stanford Emery, MD. Director of Surgical Services and Chair of Or- thopaedics at West Virginia University (Morgantown): I believe one present day challenge is supply chain management expanded through- out the system, especially a rural system such as WVUMedicine. Spine and joint implants have been around for decades now. Industry will continue to promote benefits with technological changes, but these ben- efits tend to become incrementally smaller as implants evolve toward commoditization. I think our purchasing strategies ultimately need to be linked to outcome data, but even obtaining meaningful outcome data is easier said than done. Alan Ng, DPM. Orthopedic Centers of Colorado-Advanced Ortho- pedic & Sports Medicine (Denver): Trends I anticipate are continued cost containment and the push for 'cost effective' implants and tech- niques. Patient outcomes and technology improvement unfortunately takes a back seat to profits. In the past, cost was the driving force for limitations on new products in the ASC setting and if the cost of an implant was high, we would take the case to the hospital since their contracts were better and covered the im- plants. We are now seeing a trend that even the hospitals are being very restrictive on new products even though they have better contracts. I'm assuming they would rather the physician use 'cost effective' implants to increase their margins on cases. It is becoming difficult to innovate and improve using new technology due to cost controls and facilities looking for better margins in an environment where reimbursement is constant- ly changing and unfortunately usually going down. Mark Kerner, MD. Hampton Roads Orthopaedics, Spine & Sports Medicine (Newport News, Va.): I believe hospitals will begin to set case budgets where surgeons can choose what they want to use to bring about a successful outcome, but within a set limit. at will force vendors to im- press surgeons with the cost-effectiveness of their various products as they compete to have a place in the operating room. It will allow cost efficiency and offload the decision responsibility to the physician in real time. Greg Erens, MD. Director of Adult Reconstructive Fellowship at Em- ory University (Atlanta): I can say that cost is certainly a major concern for many hospitals and ASCs when it comes to implant purchasing. Im- plant cost, however, should not be the only consideration. I think it's very important to keep in mind the success rate and implant survivor- ship of a particular implant. I do think that low-cost, high-performing implants will likely see an increased market share in the years to come. Sergio Mendoza-Lattes, MD. Associate Professor at Duke University Medical Center (Durham, N.C.): Surgeons need to be increasingly in- volved and in alignment with the health systems, for which there need to be incentives to go to limited vendor contracts. If you are suddenly forced to play with a loaner set of golf clubs and cannot use your own, performance declines and risks increase. It takes preparation and ad- ditional stress every time the procurement services people decide to change contracts. n

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