Becker's Hospital Review

55 CARE DELIVERY Cleveland Clinic Loses Orthopedic Surgeon Over Implant Dispute By Laura Dyrda O rthopedic surgeon Raymond L. Horwood, MD, moved his long-running practice from Cleveland Clinic to St. John Medical Center in Cleveland, a University Hospitals facility, in order to continue using DePuy implants for joint replacements, according to a report in e Plain Dealer. Cleveland Clinic standardized implants to just two vendors — Stryker and Zimmer — for joint replacements in a broad cost-cutting effort. However, Dr. Horwood felt Johnson & John- son's DePuy implants were better for his patients, and he chose to move his practice rather than switch implant vendors. is high-profile move emphasizes key trends in the indus- try: 1. Hospitals are instituting more sweeping changes to become efficient and cost-effective as reimbursements are reduced and they take on more risk. 2. Providers, including those at the Cleveland Clinic, are estab- lishing protocols for surgical procedures to standardize equip- ment and deliver reproducible outcomes. 3. ere are some surgeons, particularly those who have been in practice for many years, who would rather leave a hospital than change implant companies. Dr. Horwood wrote in a letter he wasn't comfortable switching implants for cost-cutting measures. Although surgeons were involved in the implant selection process, hospitals can't accommodate all preference items. In the letter, Dr. Horwood wrote, "Dr. Horwood does not feel in good conscience that he can jeopardize his patients by changing to an unfamiliar implant system simply to save money for the hospital." ere have been success stories with other models of limit- ing implant costs without giving up physician preference items. When Loma Linda (Calif.) University Medical Center adopted a "rep-less" model for implants in 2013, it received a 50 percent dis- count on implants, according to a General Surgery News report. Hospitals can also join a group purchasing organization to bargain with the device manufacturer and realize savings. How- ever, new devices oen aren't covered with GPO contracts. Other hospitals evaluate physician preference requests to keep costs down while still allowing surgeons to provide quality care. ere is huge variation in orthopedic implant costs. In Cal- ifornia, for example, the highest average cost for knee implants is $10,830 while the lowest average cost is $3,408. For hip implants, average cost ranges from $3,645 to $11,308, according to a study from Berkeley Center for Health Technology. n A Physician's Break-Up Note to Patient By Emily Rappleye A letter from a Cleveland-based University Hospitals physician serves as a reminder that the patient-physician relationship is a two- way street. Tyra Mone, MD, did not mince words with a Medina County, Ohio pa- tient, writing "Sharon Family Physicians finds it necessary to terminate our pa- tient relationship with you," according to Cleveland.com. The letter was shared with Cleve- land.com's publisher, The Plain Dealer, although the reason for the break up was not specified. The note reads, "We regret that this has become a necessity, however, no further routine professional services will be available to you from this office," according to the report. Dr. Mone declined to comment, according to the report, due to patient confidentiality. Todd Zeiger, MD, vice president of UH's Primary Care Institute, told Cleveland.com terminations happen when physicians feel their relationship with the patient is broken, perhaps because of skipped appointments, refusal to take medications or ignoring instructions. "I can think of only two or three times where I've had to make that decision in 20 years," Dr. Zeiger said, according to the report. "The message I hope the patient receives is that a different provider may be able to meet your needs better." n

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