These authors sought to describe the industry relationships in orthopaedic surgery using the information now publicly reported in the Sunshine Act Open Payments database.
They found that 12,320 orthopaedic surgeons (50%) had 58,127 industry financial relationships with a total value of $80.2 million. They compared this percentage to other surgical specialties:
Royalties or licensing fees, which were received by 1.7% of U.S. orthopaedic surgeons, accounted for 69.5% of the total monetary value of payments to orthopaedic surgeons. The number of reported relationships and the percent value for the five specialties are shown in the charts below.
Comment: "Follow the money" is a phrase attributed to Deep Throat (aka Mark Felt) the Watergate Scandal informant as portrayed in the film, All The President's Men.
The data shown in this study indicate that there is a major financial incentive for orthopaedic surgeons to develop new implants and new technologies, to speak about them, or to get 'free' food and drink while hearing about them. These new products almost always cost more that their predecessors, yet it is not often clear whether or not these 'advances' lead to better outcomes for the patient. The question 'is the incremental cost offset by the incremental value?" often goes unanswered.
The data shown in this study indicate that there is a major financial incentive for orthopaedic surgeons to develop new implants and new technologies, to speak about them, or to get 'free' food and drink while hearing about them. These new products almost always cost more that their predecessors, yet it is not often clear whether or not these 'advances' lead to better outcomes for the patient. The question 'is the incremental cost offset by the incremental value?" often goes unanswered.
This point is made clearly in the Congressional Budget Office report on "Technological Change and the Growth of Health Care Spending":
"The health care system’s rapid adoption of emerging medical technologies has, in many instances, provided enormous clinical benefits, such as prolonged life and improved quality of life. However, the added clinical benefits of new medical services are not always weighed against the added costs before those services enter common clinical practice. Newer, more expensive diagnostic or therapeutic services are sometimes used in cases in which older, cheaper alternatives could offer comparable outcomes for patients. And expensive services that are known to be highly effective in some patients are occasionally used for other patients for whom clinical benefits have not been rigorously demonstrated.
These findings suggest that some medical services could be used more selectively without a substantial loss in clinical value. Research on comparative effectiveness could provide a basis for applying costly new technologies only when they are likely to confer added benefits that are significantly greater than the benefits conferred by less expensive technologies. If placing greater emphasis on providing evidence-based care (encouraged, for example, by appropriate financial incentives for providers and consumers) resulted in the more selective use of some costly services, future spending levels would probably be lower than they would otherwise be—perhaps substantially so. Attaining significant cost savings, however, may require difficult changes to the ways in which providers and patients make decisions concerning medical care."
These findings suggest that some medical services could be used more selectively without a substantial loss in clinical value. Research on comparative effectiveness could provide a basis for applying costly new technologies only when they are likely to confer added benefits that are significantly greater than the benefits conferred by less expensive technologies. If placing greater emphasis on providing evidence-based care (encouraged, for example, by appropriate financial incentives for providers and consumers) resulted in the more selective use of some costly services, future spending levels would probably be lower than they would otherwise be—perhaps substantially so. Attaining significant cost savings, however, may require difficult changes to the ways in which providers and patients make decisions concerning medical care."
Shoulder surgeons have invented systems for 3-dimensional surgical planning, patient specific instruments, bone ingrowth implants, short stemmed humeral implants, stemless humeral implants, resurfacing humeral implants, partial resurfacing humeral implants, humeral implants with adjustable neck shaft angles, metal backed glenoids, augmented glenoid components, pain pump infusion of local anesthetics, patches for augmenting cuff repair, viscosupplementation, laser surgery, radio frequency surgery, and many more (you can see some of the 'advanced' glenoid designs here). We need to assure that these 'technological changes' are cost effective and that they are used appropriately.
Let's make sure that the ways in which we are making decisions concerning medical care is not because we are 'following the money' rather than following the best interests of our patients.
Let's make sure that the ways in which we are making decisions concerning medical care is not because we are 'following the money' rather than following the best interests of our patients.
You can find financial relationship information for any U.S. orthopaedic surgeon as shown here.
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