These authors point out that orthopaedic surgeons are responsible for a large and rapidly growing portion of the total healthcare spending in the United States. They describe some cost-containment strategies, including collaboration with vendors, value analysis teams, operating room efficiency, bundled payments, and gainsharing. They also point to barriers to cost reduction: the lack of transparency in implant pricing (because of non-disclosure clauses in the deals companies make with hospitals) and surgeons clinging to more expensive personal preferences.
Comment: In two years, U.S. Healthcare costs are predicted to reach 20% of the value of all U.S. goods and services, the GDP.
A substantial portion of this growth in national health care expenditure is related to the treatment of patients with musculoskeletal problems. Some of the drivers of increase cost are unavoidable: the need for total hip arthroplasty in patients aged 45 to 54 is expected to increase 6 times from 2006 to 2030, while the need for total knee arthroplasty in patients aged 45 to 54 is expected to increase 17 times over this period.
There are some important ways that each surgeon can contribute to lowering the cost of orthopaedic care that were not mentioned in this article:
(1) avoiding expensive imaging that does not change the treatment of the patient (e.g. no need for a CT scan in most patients with shoulder arthritis)
(2) avoiding elective surgery in patients who do not have adequate medical, mental and social health
(3) avoiding procedures of unproven value (e.g. balloon "spacers" for irreparable cuff tears)
(4) avoiding unnecessary application of technology (e.g. patient specific instrumentation for most cases of shoulder arthroplasty)
(5) avoiding implants with higher than average failure rates (e.g. metal backed glenoid components)
(6) being aware of the effect of financial conflicts of interest on presentations and publications
(7) exercising the best possible care of patients before, during and after surgery to avoid the expenses of complications and malpractice litigation.
If we are thoughtful in the way we spend money in the care of our patients today, we will go a long way to assuring that adequate resources will be there to care for our patients in the future.
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