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Total Joint Arthroplasty: Surgeons’ Perspectives on Premium Implants

The authors of the study tried to understand arthroplasty surgeons’ perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs. A total of 126 surgeons responded from 5 regions of the United States.

Going through some data, researchers have found that even though 76.9% believed new products advance future technology in orthopedics, most of them supported to inform patients that new implants lack from a long-term clinical data and restrict new implants to a small number of investigators prior widespread market launch.

The survey also revealed that 66.7% would pass on gainsharing incentives in exchange for more freedom to choose implants and 76.9% defended that patients should be allowed to pay incremental costs for “premium” implants.

20 years have passed and the increasing costs for total hip arthroplasty and total knee arthroplasty have outpaced increases in refunds. Implant costs involve up to 50% of Medicare’s refunds for the entire procedure and hospitalization. This rise in costs without a comparable rise in reimbursement threatens hospitals’ financial stability and may therefore reduce patient access to care.

There are attempts to realign hospital and physician incentives by compensating surgeons for making cost-effective decisions that yield savings for the hospital. Compensation may be in the form of bonus payments, additional organization resources such as physician assistants, research funds, or another item of value to the physician or the department. Surgeons may obtain small rewards from gainsharing and they may have less autonomy to choose the implants they believe are best for their patients.

Even though most arthroplasty surgeons believe that technological innovation advances in the field of orthopedics, supporting the “unproven” nature of the new implants with patients, most respondents prioritized patient beneficence and surgeon autonomy above personal financial gain.

Eventually, hospitals will need to address implant costs to ensure that they remain solvent. Data also revealed that many arthroplasty surgeons support alternative payment models that permit both the surgeon and the patient to retain autonomy regarding implant selection.

 

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