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Trauma Surgeon: Value-Based Orthopaedic Care Can Positively Impact U.S. Healthcare

Peter Althausen, M.D. received his medical degree and MBA in healthcare administration from Tufts University School of Medicine. In clinical practice, he specializes in the treatment of pelvis and acetabular fractures, periarticular fractures and complex polytraumatic injuries. Dr. Althausen teaches and mentors in his role as a Clinical Assistant Professor at the University of Nevada School of Medicine. He is also Chairman and Treasurer of the Orthopaedic Implant Company, a value-based device company founded in 2010 that has over 20 FDA-cleared products.

You are a surgeon, teacher, researcher and chairman of a device company. Across your roles, what do you see that excites you about orthopaedics?

Dr. Althausen: I am always excited by interactions with new medical students and fellows who continue to demonstrate commitment to patient care and research fueling changes in the healthcare system. Their new ideas and perspectives will drive the next generation of physicians and medical discovery.

Treatment solutions with excellent outcomes now exist for the majority of traumatic injuries. Now that we have solved these problems clinically, I am excited by the impact value-based orthopaedic care can have on American healthcare. As physicians take on personal responsibility for this change, their actions will result in unprecedented cost savings, turning the tide for an overburdened system with an unsustainable economic trajectory. A large majority of trauma patients are uninsured or underinsured and value-based implants allow us to provide more cost effective care for this challenging patient population. It’s no longer enough to focus solely on the clinical aspects of care. As surgeons, it’s now our moral obligation to deliver great care with fiscal stewardship as well.

At OMTEC 2018, you spoke in the Surgeon Pod about market forces driving value-based care. State your case: what are those forces, and what are value-based implants? Why are they a better choice?

Dr. Althausen: The majority of orthopaedic devices have now become commodities. Devices coming to market today have not demonstrated improved outcomes, yet carry hefty price tags that are unaffordable for the majority of hospitals and patients. Clearly there’s no winning argument to pay more for devices that do not improve outcomes. Furthermore, the overwhelming majority of these new and expensive implants are approved by the FDA through the 510(k) process, which by definition, means the device is “substantially equivalent” as similar devices on the market and in use today. Health insurance companies and the government are now realizing this fact, creating market forces that are driving better value for our healthcare dollars.

You are speaking to engineers and their executive leaders at companies of every size in orthopaedics and spine. What do they need to learn and embrace about value-based implants?

Dr. Althausen: Companies must accept that the value-based market is here to stay. Generic medication has done wonders for saving patients money. While a specialty plate or nail might prove to be beneficial for outlying indications, the majority of devices used in the most common cases for internal fixation are generic in nature and should be priced accordingly.

Are high-value implants the same as generic devices? If not—what’s the difference between them?

Dr. Althausen: Semantically, they are not, but with regards to economic impact, they are. A generic is a true copy of an existing device, while high-value implants are proprietary designs offered at a lower cost. In general though, ”high-value implants” has become a catch phrase and does not carry the negative stigma some place on the word “generic.”

What tools do you wish you had at your disposal today, as a trauma surgeon?

Dr. Althausen: I wish I had every surgeon’s cost-per-case data at my fingertips. The biggest roadblock I see in value-based implants gaining critical mass is the lack of understanding surgeons have regarding the savings they can generate for patients by making better decisions on implant selection. Very few hospitals are transparent enough with their surgeons to evoke the response U.S. healthcare needs. Surgeons are scientists and make decisions supported by data. If we readily share data with them, in this case, implant and intra-operative costs, they will make better decisions. Furthermore, surgeons can and should be rewarded for creating better value for their hospitals. With data, they can better understand the opportunity and align with the hospital for a triple win; the patient, the facility and themselves.

Julie Vetalice is ORTHOWORLD’s Editorial Assistant. She can be reached by