The thesis of this article is that "Many of physicians’ daily decisions — such as their selection of drugs, devices, and technologies, and the amount of time they utilize resources such as operating rooms and hospital beds — have a significant financial impact on hospitals. By providing physicians with the appropriate incentives, hospitals and health systems can enlist them in the effort to manage costs while simultaneously maintaining or improving patient outcomes."
This article tries to answer five questions:
1. Broad or Narrow Incentive Structures?
2. Individual- or Team-Based Incentives?
3. What’s the Right Timeframe for Compensation?
4. How Much to Compensate?
5. Financial or Alternative Forms of Incentives?
Surgeon decisions such as
preoperative plain films versus 3D CT scans,
anatomic versus reverse total shoulder for osteoarthritis,
standard versus augmented glenoid components,
general anesthesia versus general anesthesia + interscalene block,
transosseous cuff repair versus double row suture anchor repair, and
cuff repair alone versus cuff repair with a patch
have a substantial impact on the cost of care, yet their impacts on patient comfort and function are not well defined.
Surgeons determine other costs that are harder to measure and harder to include in an incentivization scheme, for example
the cost of disposables versus reusables,
the cost of opened but unused implants,
the cost of sterilizing unused instruments, and
the cost of getting rid of the trash from each surgical case.
It is interesting that surgeons make different (more economical) choices about expenditures when they perform surgery in an ambulatory surgery center in which they have a financial interest in the bottom line as opposed to performing the same operation in a medical center in which they do not have a financial interest.
There are many ways to get good outcomes while spending less money. Some are pointed out in Optimizing patient outcomes by spending health care dollars wisely. If we can get good comes for less money, it's a win. Sometimes this can be accomplished by doing less. A favorite non-orthopaedic example is the scooter bike. We all know that outcome we want for our kids learning to ride a bike is good balance. The expensive approach is to get a bike with training wheels. However this does not teach balance, it teaches dependency on training wheels. 
The less expensive approach is the scooter bike that has no training wheels, yet safely teaches the child balance.
Can you think of analogs to the scooter bike in shoulder surgery?
In fiscal year 2023, healthcare expenditures made up about $1.4 trillion out of a total federal budget of roughly $6 trillion, or about 23-25% depending on exact allocations. This percentage is rising annually. As surgeons we are in a strong position to reduce health care costs by making informed decisions about the technologies we use and those we advocate.
Each of us should be on constant lookout for ways to reduce the cost of health care, even if we're not incentivized to do it - it's the right thing to do.
You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link
Follow on twitter/X: https://x.com/RickMatsen
Follow on facebook: https://www.facebook.com/shoulder.arthritis
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).