Hip and Knee Implant Cost Containment

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A growing number of health systems are considering a shift toward a “rep-less” operating room to help curb costly implant prices and optimize the surgical episode. The rep-less concept has always intrigued hospital leadership because of the tremendous cost-savings potential — and opportunity to minimize bias that might come from the presence of a manufacturer sales rep.

But making the transition to implant surgery without a rep to help can prove challenging. However, thanks to an emerging clinical acceptance of value-based, or generic, medical devices and more resources available to hire trained staff to take over tasks now done by sales reps, the shift is more feasible than ever before.

Those looking to make the switch to “rep-less” do face barriers, which need to be addressed, specifically:

• Negotiating the sometimes strong personal relationships between surgeon and sales rep
• Finding reliable, cost-effective strategies to fill the knowledge gap created by the rep’s departure

Overcoming these hurdles can have a significant payoff. In fact, it has been estimated that as much as 40 percent of premium-priced orthopedic implant costs are sales costs — associated with the actual sale rather than with the value of the device. Every hospital is unique and each needs to take a customized journey to optimize the surgical episode without a sales rep. Still, if you’re exploring this strategy for your organization, start by considering these key factors as best practices for a successful rep-less transition. These include:

• Determine rep-less readiness

Evaluate your manufacturer dependencies. That way you will know what gaps will occur when the rep is removed from the OR. Include a thorough review of implant costs and metrics that compare the true value of the rep relative to that cost. The evaluation will also help identify gaps in cultural readiness and provide a roadmap for areas of focus that will sustain the rep-less model long-term.

• Enhance clinical support

Identify clinical resources that can reduce your clinical dependency on the sales rep. Ensure that specialized knowledge about back-table set-up, implants, devices and procedure techniques are known by trained surgical first assistants (SFAs), typically MDs or PA-Cs who have undergone advanced training. For example, there are some SFAs that have, on average, reduced procedure time by as much as 30 percent and increased surgical throughput by up to 42 percent.

• Optimize operational and clinical processes

With clinical support in place, begin process redesign initiatives to support additional efficiencies and independence. Three key processes to consider overhauling include: 1) disciplined tools that enhance operational productivity, reduce risk and optimize workflow based on financial, time, safety and satisfaction ,metrics, 2) human-centered design that helps improve the experience people have with technology, process and each other, and 3) access to internal clinical best practice guidelines that ensure optimal safety and patient outcomes. These tools can help reduce surgery cancellations, improve pre-op and supply chain efficiencies and improve HCAHPS scores, just to name a few benefits.

• Introduce value-based technology

The final step on the rep-less journey is to introduce equally effective, alternative implant options to help further reduce implant costs. Clinical results show that premium-priced orthopedic implants are failing to show incremental benefits over more standard devices. Value-based technologies are FDA-cleared device designs that are typically less complex and show no difference in clinical outcomes from comparable premium devices. The significantly lower total cost and reduced reliance on sales reps make value-based technologies increasingly more appealing.

Even though each hospital’s journey is distinct, ongoing management of the clinical and operational processes in each of these critical steps will help you trim more than implant costs, they will allow you to take more control over your OR and achieve an optimized rep-less surgical episode…

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