Implant selection and cost for total joint arthroplasty: conflict between surgeons and hospitals

Total joint arthroplasty is a successful surgical treatment for painful, arthritic hips and knees. The prevalence of total joint arthroplasty is increasing, and it is consuming an increasing proportion of health care dollars. Payers, especially Centers for Medicare and Medicaid Services, have targeted total joint arthroplasty for cost control, and joint implants, the greatest expense in total joint arthroplasty, have been identified as an opportunity for cost control. Hospitals seek to control the cost of joint implants because the rate of increase in the price of implants is rising faster than the rate of increase in hospital payment for total joint arthroplasty. As joint implants consume more of the hospital payment for total joint arthroplasty, hospitals are encouraging surgeons to use less expensive implants. Several methods for controlling the cost of implants have been described, but no method has succeeded without the cooperation and involvement of surgeons. Gainsharing programs may help align the incentives of hospitals and surgeons relative to the selection and cost of implants. We have implemented a Single-price/Case-price Purchasing program with considerable savings on the cost of implants without adversely affecting the patient outcome of total joint arthroplasty.