Surgeons have stressful, high-stakes jobs. Luckily, they receive years of academic and practical training to help them prepare. However, patients, the ones putting their lives on the line each day, don't have that same training.
So, it's not surprising that when patients enter the four walls of a hospital, they are flooded with fear and anxiety. They're worried about the procedure itself, the recovery period, their quality of life, and the impact on their loved ones pacing around the waiting room while they're under the knife.
But most patients don't worry about the care delivery that starts before their pre-op visit or when they're wheeled into the operating room. They don't think about the care that starts before they're even admitted, including the evaluation of medical devices and clinically-sensitive supplies.
Patients don't worry because they have no idea that the process that they go through when buying a new car may be more rigorous than the process that hospitals, including their carefully-chosen surgeons, use to decide which implants and supplies to use during the procedure.
What Patients Don't Know and Wouldn't Believe
A Procured Health survey of over 100 hospitals found that only 28% of respondents consistently reviewed critical safety information like adverse events and FDA or vendor product recalls prior to choosing medical devices. Similarly, only 25% of respondents evaluated comparable products to see if they provided superior clinical outcomes instead of just purchasing the product requested by the physician. Even more concerning is that 73% of survey respondents said that vendors are their primary source for clinical information.
Is that the due diligence that surgeons or hospital administrators would want for their own families? Clearly not.
And if the potential harm to patients wasn't enough, these poor decisions also have dire financial ramifications. Estimates show that hospitals will overspend on supplies and devices by as much as $35 billion in 2016—all of this overspending while the U.S. still ranks last in outcomes according to a 2014 Commonwealth Fund Report. Since these dollars aren't helping patients, the need for change is even more urgent.
Physicians must play a more active role as partners for supply chain leaders, who are responsible for product and utilization decisions, This partnership is critical because vendors understand change cannot happen without physician support. When physicians get involved, vendors are often willing to help facilitate hospitals' cost containment goals without hindering clinical choice.
Shifting the Focus Back to Evidence
In our conversations with over 350 hospitals, we've identified a big opportunity for improvement. It's based on one key strategy: committing to an evidenced-based approach.
Procured recently conducted a survey of 101 orthopedic surgeons and electrophysiologists. It found that physicians rely on device vendors as their primary source of product information. Similarly, vendors were the most accessed source of information, although the same physicians recognized that their information biased and unreliable.
However, in most cases, despite strong vendor relationships, the reliance on vendors for information isn't a conscious choice. It's a symptom of the fact that more reliable data sources aren't as readily available to physicians, who despite being knowledgeable, educated, and well-read, can't keep up with the massive amount of clinical research being published and products being introduced—or at least they cannot keep up while doing their jobs and managing to get any sleep.
Partnering to Drive Change
To overcome this challenge, surgeons should partner with strong supply chain or clinical excellence teams who can provide a comprehensive overview of peer-reviewed literature on requested devices and insight into the comparable products on the market. Physicians can review and make their own, evidence-based decisions—without the "support" of a device rep. More importantly, this partnership ensures that physicians and patients get the best devices based on science.
Keeping the Focus on Evidence
Making an evidenced-based decisions once is easier than remaining steadfast to that approach. We've found that one of the biggest challenges of truly committing to this strategy is the lure of new technology. New product introductions are a significant contributor to cost inflation at most hospitals. Savings from efforts to standardize products are often depleted by new technologies that are purported to yield significant benefits over existing therapies.
Committing to an evidenced-based approach requires surgeons to critically evaluate vendors' claims that their products are more innovative, ground-breaking, and unlike anything else on the market today. While surgeons are right to want to have the best for patients, the clinical evidence associated with new technologies doesn't always support superior outcomes. In fact, as a recent article in the British Medical Journal illustrated, new technologies may actually pose more safety risks.
For example, vendors touted that there was increased flexion and decreased anterior knee pain with the introduction of high flexion components in total knee replacement, but the evidence didn't support the claims. It found no improvement in medium-long term clinical benefits.
That's what matters: Patients don't care if they're receiving the newest, most expensive medical device, they just want the one that will ensure a better quality of life—and that's what we all deserve.
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