Surgeons likely have very little insight when it comes to the price tag of the devices they implant in patients, a survey of orthopedic surgeons shows. Educating them on both cost
and effectiveness is key to ultimately helping hospitals save money, experts agree.
implanting devices have much more access to clinical data about efficacy and safety than data about pricing,” said Diane Robertson, director of health technology assessment information for the ECRI Institute
. “But when physicians are able to look at the clinical and cost evidence together, they are very willing and like being able to include cost as part of their decisions.”
For a Health Affairs report released Monday, researchers surveyed 217 attending physicians and 286 residents about the estimated price tag of 13 common orthopedic devices. The results: Physicians were only within the ballpark in estimating cost 21% of the time, and residents 17% of the time.
“In some instances, there were only subtle differences that make one device different from another, and if there are marked differences in price, one would think the device with the lowest price might be the one chosen. This report finds that's not what happens,” said Dr. Andrew Pollak, a professor of orthopedics at the University of Maryland School of Medicine and co-author of the report
“I anticipated that the level of knowledge would be low, but I was surprised by how low,” he said. “It is surprising they we are implanting devices that are very expensive and don't know or understand how much of the healthcare dollar we are spending.”
Asking physicians what the devices cost is “like playing a game of 'The Price is Right,'” Robertson said. One of the main ways to educate physicians is to engage them in the activities of the hospital value-analysis committees, which often arise out of the supply-chain departments. “It's in this forum that cost, safety, clinical and reimbursement data can be shared for the most informed decisionmaking.”
Historically, clinical and supply chains
have not interacted, but hospital systems such as Fletcher Allen Health Care of Burlington, Vt., say physician involvement in value-analysis has helped it save more than $500,000 each year.
“We engage clinicians as colleagues and subject matter experts, from cardiology to orthopedics. Our physician colleagues work side by side with supply-chain staff in jointly making the supply and equipment decisions that are best for our patients,” said Charlie Miceli, the hospital's vice president for information technology and supply chain. “We collaboratively manage our resources, ensuring both clinical and financial efficacy, which allows us to sustain our business in a very dynamic economic environment and ultimately provide the best resources to take care of our patients."