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5/11/2013
1
CLINICAL USE OF GENERIC
CANNULATED SCREWS
Tim Bray M.D.Reno Orthopaedic Clinic
CONFLICTSBoard Member for Implant Company Flex-fix, Anthem
Orthopaedics
BOARD MEMBER FOR A GENERIC IMPLANT COMPANY
Orthopaedic Trauma Association- Board
Fellowship Funding: OTA/COTA, Renown Regional Medical Center
CONFLICTSRECEIVE THE SAME FINANCIAL
REWARD FOR THIS PRESENTATION AS I DO FOR ALL OTHER
ORTHOPAEDIC ENTREPRENURIALISM COMBINED
CONFLICTSI RECEIVE THE SAME FINANCIAL REWARD FOR THIS PRESENTATIOIN
AS I DO FOR ALL OTHER ORTHOPAEDIC
ENTREPRENURIALISM COMBINED
5/11/2013
2
WHAT DO WE SPEND ON HEALTHCARE IN THE
UNITED STATES ?
$
US Healthcare = French Economy
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3
Expenditures per Capita 2006
data from WHO http://www.who.int/en/
Percent Health Care of GDP 2006
data from WHO http://www.who.int/en/
IMPENDING HIP FRACTURE CRISIS US POPULATION PYMARID
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4
Total Hospital and Physician Costs
13
Hip Replacement (US$)
Primary and Revision TJA Procedures Performed in the US
0
500000
1000000
1500000
2000000
2500000
2000 2005 2010 2015 2020 2025 2030
Year
Nu
mb
er o
f P
roce
du
res
Primary TJA
Revision TJA
Projections*
(down 39%)
(up 171%)
$
1994 2006
Implant Prices
Surgeon Reimbursement
Hospital Profit (down 92%)
Joint Replacement Surgery
JBJS, vol 88-A 2006
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GENERIC ORTHOPAEDIC IMPLANTS
PROVIDE AN IMMEDIATE
OPPORTUNITY FOR SURGEONS TO HELP CHANGE
OUT OF CONTROL HEALTHCARE SPENDING
ALL COMPETE WITH EACH OTHER-BUT NO LOW COST
ALTERNATIVE
Example…
$238 $98
“SCREW COMPANY” GENERIC SCREW COMPANY
HOW DO GENERIC IMPLANT COMPANIES WORK?
IMPLANT DESIGN PATENTS EXPIRE…GENERIC
COMPANIES COPY, TEST, OBTAIN FDA APPROVAL…
MANUFACTURE PRODUCTS… SELL VIRTUALLY…
IMPLEMENT REP-FREE MODEL
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Anatomy of a $1200 Screw
Sales and Marketing43.3% ($519.60)
R&D 4.4% ($52.80) Manufactering 8.1%
($97.20)
Overhead 3.4% ($40.80)
Net Margin 40.8% ($489.60)
Sales and Marketing
REPS COMMISSIONFANCY BROCHURES
PHYSICIAN TRAVEL PERCS
Example…
$238 $98
“SCREW COMPANY” GENERIC SCREW COMPANY
GENERIC SAVINGS ON DRUGSDrug Pricing
Research on Savings from Generic Drug UseGAO-12-371R, Jan 31, 2012
1999-2010 STUDY PERIOD$1 TRILLION SAVINGS
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STUDY HYPOTHESIS HYPOTHESISHIGH QUALITY GENERIC
CANNULATED SCREWS PROVIDE EQUIVILANT OUTCOMES IN THE TREATMENT OF FEMORAL NECK FRACTURES AND CERTAIN
POSTERIOR RING INJURIES OF THE PELVIS AT A LOWER COST
RENO ORTHOPAEDIC CLINIC TRAUMA FELLOWSHIP MATERIALS/METHODS
IRB APPROVAL
7.3 MM GENERIC CANNULATED SCREWS@ REGIONAL COMMUNITY TRAUMA CENTER FOR ORIF FEMORAL NECK FRACTURES AND CERTAIN PELVIC FIXATION
COMPARED DATA TO 2010 TRADITIONAL IMPLANT PATIENT POPULATION; CHART, CLINICAL VARIABLES REVIEWED, RESULTS BLINDED, DATA ANALYZED SAS VERSION 9.2 WINDOWS; LEVELS OF SIGNIFICANCE SET @ P<.05 BY UNIV. NEVADA STATS DEPT.
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TYPICAL SCREW CASES RESULTS SI SCREWS� SI- 44 PATIENTS 2010; 35 PATIENTS 2011
� 63% MALES� 40%APC, 50%LCP
NO SIG DIFFERENCES-AGE, SEX, ASA, FRACTURE PATTERNS
OUTCOME DATA SAME IN BOTH GROUPS TIME OR, COMPLICATIONS, OUTCOMES, NO IMPLANT FAILURES
IN EITHER GROUP
COST SAVINGS ANALYSIS
AVERAGE SAVINGS/CASE= $327
73% REDUCTION
$15,878/YEAR
RESULTS FEMORAL NECK SCREWS
50 PATIENTS 2010; 45 PATIENTS 2011� 70% FEMALE = BOTH GROUP
NO SIG DIFFERENCES-AGE, SEX, ASA, FRACTURE PATTERNS
OUTCOME DATA SAME IN BOTH GROUPS TIME OR, NO MAL UNIONS, FAILURES, REPEAT SURGERY OR
HOSPITAL PARAMETERS
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COST SAVINGS ANALYSIS
SAVINGS= $579/CASE
67% REDUCTION
$34,653/YEAR SAVINGS
RESULTSTOTAL COST SAVINGS FOR STUDY PERIOD $50,531.00
WITHOUT ANY CLINICAL DIFFERENCE IN HOSPITAL,
OPERATIVE, OUTCOME PARAMETERS
DISCUSSION
DISCUSSIONFIRST TRAUMA STUDY TO DOCUMENT GENERIC IMPLANT COST SAVINGS IN
CLINICAL PRACTICE
SMALL PILOT PROJECT- QUALITY GENERIC IMPLANTS WORK
IN A $3 BILLION DOLLAR TRAUMA MARKET GREAT SAVINGS POTENTIAL
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‘VALUE ADDED SERVICES’
� GENERIC IMPLANT PROGRAMS
‘VALUE ADDED SERVICES’� GERIATRIC FRACTURE PROGRAM� OWN THE BONE� COMMUNITY OUTREACH� EDUCATION� PUBLIC RELATIONS� EXPANSION SERVICES� COST CONTAINMENT-MATRIX PRICING� GENERIC IMPLANT PROGRAMS� OPERATING ROOOM EFFICIENCY� BIOLOGIC UTILIZATION PROTOLS� GATEKEEPERS
GROWTH BARRIERSCONFLICT OF INTEREST
CURRENT STUDY AUTHORS ARE STOCKHOLDERS-DATA BLINDED REVIEWERS
PATIENT PERCEPTION-LESSER IMPLANT QUALITY?
ORTHOPAEDIC SURGEONS LOVE THEIR REPS
WE HAVE A PERSONAL OBLIGATION TO BECOME
INVOLVEDBRINGS REVENUE TO HOSPITAL’S BOTTOM LINE
DEMONSTRATES PHYSICIAN COMMITMENT TO COST CONTAINMENT
SAVINGS CAN BE DIRECTED TO UNFUNDED AAOS/OTA/AOA MANDATES
WITH ACO’S- IMPROVE PHYSICIAN/INSTITUTIONAL INCOME MARGINS.
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THANK YOU