Hospitals have plenty of room to cut costs and improve efficiency in total joint-replacement procedures, according to a new analysis.
The report by Premier Inc. found significant variations in the price of medical devices and other supplies, such as a $1,500 difference in the cost of knee implants between the highest and lowest performing hospitals and a $1,700 difference for hip implants.
If hospitals can close those price gaps, they could save $23.7 million for knee replacements and $19.1 million in hip replacements, according to the report. The study looked at procedures at 869 hospitals between October 2015 and March 2017.
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Many hospitals have just accepted prices as a step to improving patient outcomes, even though the data don't necessarily bear that out, Robin Czajka, R.N., service line vice president of cost at Premier, told FierceHealthcare.
Czajka said it's important that surgeons are provided concrete data such as Premier's report that can give them the push they need to rethink their ordering habits. "You need to make sure you're able to sit down with physicians proactively about cost, and have an informed conversation about that," Czajka said.
In addition to the variation between the costs of surgical implants, the Premier researchers found that anesthesia, operating room time and bone cement options are also areas hospitals can look at to cut costs.
Just 22% of total joint-replacement patients are given local anesthesia versus general anesthesia, but the jury is still out on whether general anesthesia leads to better outcomes for the patient, according to the report.
Local anesthesia is less expensive, and expanding its use for joint replacements could lead to significant cost savings, according to the analysis.
"General [anesthesia] still seems to be fairly preferred, and that is a big impact," Czajka said. "Reducing that could have very positive effects on patient outcomes, and reducing general anesthesia shows patients options."
Hospitals that performed the best joint replacements also had lower operating room labor costs, according to the report. High-performing facilities accounted for about $2,000 in OR labor spend, compared with $4,600 in lower-performing hospitals.
An operating room that follows a lean management style, or a systematic method for waste minimization, will be more efficient and ensure the number of people in the OR are those who are most needed, Czajka said.
A lean approach can also reduce overuse of antibiotics—including pricey antibiotic bone cement—further reducing costs.
"Physicians really think they're doing the best in front of infection," Czajka said. "But it doesn't really have a statistical impact on infection rates."