Hot Topics in Orthopedics

When it comes to the latest trends in orthopedics, conversations run the gamut from the latest knee replacement in the marketplace to the Zimmer/Biomet consolidation and government mandates such as ICD-10. These conversations primarily focus on the sea change many feel coming not only in orthopedics, but also in the overall healthcare industry.

“There are new and innovative products being introduced, but the overwhelming theme is ‘Let’s see where healthcare is going’ and ‘How do we plan and react to that?’ ” says Richard Conn, M.D., orthopedic surgeon at Wesley Medical Center in Hattiesburg, Mississippi, as well as an industry speaker and co-medical director for Stryker Performance Solutions.

New Products

When it comes to industry advances, new products include a series of innovative knee implants from various manufacturers.

Biomet has launched the Vanguard XP TKA system, a knee replacement product that allows both cruciate ligaments to be preserved. Biomet claims that this bi-cruciate retaining total knee allows a more natural feel because the patient can keep the anterior cruciate ligament, as well as the posterior cruciate ligament, which traditionally would be removed for a knee replacement.

“The main pro of the Vanguard XP is that patients say that it feels more natural, but this is difficult to quantify,” says Anne Preston, director, SourceTrust.

DePuy Synthes also introduced a rotating platform option for its Attune Knee, which is marketed as offering more mobility and flexion. Smith & Nephew launched the Journey II CR Knee, a posterior cruciate retaining knee that allows patients to keep the posterior cruciate ligament and thus preserve more normal motion.

Stryker added the Triathlon Tritanium Knee System to its offerings, providing a knee with a highly porous fixation surface previously used only on Stryker’s hips.

“The Triathlon isn’t new and the Tritanium isn’t new, but by combining the two, Stryker was able to launch an additional option to its existing knee,” Preston says.

Robotics continues to get a lot of attention, especially with Stryker’s fourth quarter 2013 acquisition of MAKO Surgical Corp., a pioneer in the advancement of robotic arm-assisted orthopedic surgery.

“How interest in robotics will translate into utilization has yet to be seen, but certainly there was a lot of interest at the recent AAOS [American Academy of Orthopaedic Surgeons] meeting around that concept,” Conn says.

New Models for Service

The latest innovations are coinciding with a shift in how these devices are supported in the hospital setting. A new “aligned service model” is emerging as a cost-reduction solution. In an aligned service model setting, the duties of a supplier representative are being accomplished by members of the OR staff.

As Preston explains, “The approach, sometimes referred to as a ‘rep-less model,’ has OR staff trained to take over the role of device company reps during routine surgical cases. On complicated cases, they can seek help from participating suppliers or traditional implant providers.” Implant Partners, Ortho Direct and S2 Interactive are three suppliers that are actively working this new model in the market.

Another shift with economic overtones is the trend among companies to partner with orthopedic surgeons—and not just for hips and knees. “Orthopedic suppliers also want to have your shoulder business, your trauma business and your small joint business,” Preston says.

The relationship may include offering better prices on hips and knees if the orthopedic surgeon also will utilize the company for various other categories.

“Suppliers are taking the stance that they want to partner with you,” Preston says, “and partner across the board.”

At the same time that suppliers are working to broaden product offerings, the orthopedics industry is consolidating. Zimmer’s acquisition of Biomet, on track to finalize the second quarter of 2015, has created a raft of questions, according to Conn.

“What impact will this consolidation have on its distribution models and service? How will the consolidation impact surgeons and the availability of products? Will this cause orthopedic implant companies to focus on further consolidation?” he says are common questions.

The Zimmer/Biomet consolidation also will cause “a lot of redundant technology between the two companies,” Preston adds. With four knees to now support, “we assume there will be some obsolescence.”

ICD-10 and the Affordable Care Act’s Impact

surgeryAs business models are changing from within, external forces are causing far-reaching changes across healthcare in general. ICD-10 codes have been the source of some of this stress, Preston says. According to AAOS, the new ICD-10 codes—increasing the set of billing codes from 14,000 to more than five times that number—were set to be implemented October 1, 2014. A surprise vote by the U.S. House of Representatives in March 2014 has delayed implementation for at least one year.

“There has been a lot of anxiety about ICD-10,” Conn says. “Most surgeons have no idea how it will impact their practices, in terms of the costs of acquiring technology, required training  and time away from practice, and … productivity. That is a big cloud hanging over the process.”

Likewise, the orthopedic community is unsure about the long-term impact of the Affordable Care Act.

“If you use the analogy of railroad tracks starting in one direction and then splintering off in many crazy directions, that may be the way to describe some people’s feelings about the healthcare environment now,” Conn says.

Conn believes the transparency aspect of the ACA is even more of a hot topic for orthopedic surgeons than any new products on the market. Transparency is certainly an important aspect of 2012 data on physicians and surgeons recently released by the Centers for Medicare and Medicaid Services (CMS).

“Now patients can go to the government website, see how many procedures a surgeon actually did and how much Medicare paid,” Conn explains. The transparency of data collecting and reporting is a dramatic procedural change for healthcare professionals, he says.

“Will the release of CMS data actually influence a surgeon’s utilization of products and services? It might,” Conn predicts.

A Focus on Quality Outcomes

While changes and potential upheavals have resulted in an uncertain season in orthopedics and healthcare as a whole, Conn is optimistic that over time—and with incremental steps—the results will lead to the common goal of improved patient care.

“Going forward, surgeons will have to face the concept: You have to provide a quality outcome for your patient, but now at the lowest possible cost,” he says. “It’s no longer ‘I want this widget or I want them all right now.’

“That attitude is not going to survive,” Conn continues. “Now I have to stop and think about the cost of the product or service and how it positively impacts the patient’s outcome and the institution in which I work. These changes are going to require surgeon participation and tremendous time and energy spent being champions of process and change.

“How surgeons and institutions adapt to the concept of change will have a lot do with their success going forward,” Conn adds. “The bottom line: Be prepared.”

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