When a hospital agrees to limit the number of orthopedic device vendors at their facility and standardize surgical procedures, some private practice surgeons fear that being required to use a new and unfamiliar implant system to save costs may jeopardize patient care.
Cleveland Clinic Limits Implant Vendors – Surgeon Leaves
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Ray Horwood, M.D. at the Cleveland Clinic’s Fairview Hospital is one such surgeon. Rather than use a new implant system, he decided to move his practice on October 1, 2015. Horwood is a big deal at Fairview where he was physician of the year in 2011. He works for Orthopaedic Associates but housed his practice at Fairview.
According to a September 10, 2015 Cleveland Plain Dealer story, Horwood wrote a letter to his patients saying the decision to limit implants was prompting him to take his practice to St. John Medical Center, a University Hospitals facility in Westlake, Ohio.
The letter from his practice said that Dr. Horwood, “does not feel in good conscience that he can jeopardize his patients by switching to an unfamiliar implant system simply to save money for the hospital.”
To be fair, we have heard of no evidence that hospitals that limit vendors have worse outcomes.
Stryker, Zimmer Biomet and DePuy Synthes
The Cleveland Clinic has limited implants to Stryker Corp. and Zimmer Biomet Holdings, Inc. Horwood has been a DePuy Synthes guy for 28 years.
In his letter to patients, Horwood did not directly express concerns about the quality of the Stryker and Zimmer products. But he indicated switching to those products from DePuy could undermine the effectiveness of his care.
Hospital executives say it’s not just about money but to generate more consistent results, improve quality, and cut costs. The Clinic’s Chief of Staff Brian Donley, M.D., also an orthopedic surgeon, told the Plain Dealer that the process to standardize procedures can lead to conflicts among physicians.
“It doesn’t always make everyone happy, ” Donley said. “There is a tremendous amount of change going on in health care as we work to drive quality, but do it in a more affordable way.”
The letter to Horwood’s patients ended with, “Dr. Horwood would be happy to discuss this further should you have any questions regarding the Cleveland Clinic purchasing initiative or his decision to put patients first.”
A Clinic spokeswoman noted that several of the physicians who work within Horwood’s independent doctor’s group are staying at Fairview Hospital.
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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