The new healthcare reality is one of accountability for both surgical outcome and costs. We have had the ability to innovate in our surgical center such that we have significantly lower costs while maintaining the highest level of outcome. There has been a trend towards bundled payments and an abolition of carve out for medical devices. This has caused downward pressure on the surgeons requiring them to become part of the process.
Our surgery center has refined our approach through streamlining choices, maximizing efficiencies and utilizing low-cost implants such that we can perform a three anchor rotator cuff repair for a total supply cost of $350 (see figure 1).
Figure 1- Itemized supply costs for a rotator cuff repair.
How have we done this? First and foremost is the usage of a low-cost shoulder implant. We utilize RoG Sports Medicine's FDA approved rotator cuff and knotless anchors. The rotator cuff anchors are an all-PEEK design, double loaded with high tensile strength suture and costs $49. Their PEEK knotless anchor costs $29. By utilizing stable technology and a low-cost approach, they have created an equivalent technology with significant cost-reduction. We do not utilize sales reps at this price point. A similar two anchor rotator cuff repair performed at an area hospital recently cost $1,337 for implants alone (Figure 2).
Figure 2- EOB from hospital case.
The next step in achieving efficiencies is the utilization of a standard pre-assembled package (see figure3).
Figure 3- Custom Pack.
This package includes most essential material to perform an arthroscopic rotator cuff repair. This allows us to efficiently manage and achieve a bundled cost-reduction of our surgical supplies. The cost of our pack is $88.
We have innovated on the side of other physician preference devices. We internally reprocess our shaver blades such that our cost per use is $10. Rather than utilizing an expensive thermal device, we merely attach a hook Bovie probe to our electrosurgical pencil at a cost of $32.
We also have achieved significant cost savings by the utilization of a simple technique to achieve gravity inflow rather than utilizing a pump and all the necessary tubing. Gravity inflow works best in a hypotensive anesthesia situation which we recommend utilizing only for lateral shoulder arthroscopy. Hypotensive anesthesia in the beach chair position has resulted in case reports of blindness secondary to hypo perfusion.
When the surgical facility and surgeon are open to innovating via creating efficiencies and utilizing low-cost alternatives, significant cost savings can be achieved. We have demonstrated that our total supply cost to perform a 3 anchor rotator cuff repair is $350. We understand that surgeons will continue to have certain physician preference that they feel they must maintain in order to achieve the level of care that they seek. We have shown that we can maintain the highest level of patient care and outcome while also achieving the cost savings that are required in the current healthcare environment.
Blair Rhode is a sports medicine orthopedic surgeon that also owns his own surgery center. He is also the founder of RoG Sports Medicine (www.buyrog.com), the first generic manufacturer that offers a complete line of shoulder implants. Feel free to contact Dr. Rhode at
How I Can Do a Rotator Cuff Repair for $350 FeaturedWritten by Blair Rhode, MD, Sports Medicine Physician & Founder, RoG Sports Medicine | May 01, 2012
This article is written by Blair Rhode, MD, Sports Medicine Physician & Founder, RoG Sports Medicine.
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