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CLINICAL USE OF GENERIC

CANNULATED SCREWS

Tim Bray M.D.Reno Orthopaedic Clinic

CONFLICTSBoard Member for Implant Company Flex-fix, Anthem

Orthopaedics

BOARD MEMBER FOR A GENERIC IMPLANT COMPANY

Orthopaedic Trauma Association- Board

Fellowship Funding: OTA/COTA, Renown Regional Medical Center

CONFLICTSRECEIVE THE SAME FINANCIAL

REWARD FOR THIS PRESENTATION AS I DO FOR ALL OTHER

ORTHOPAEDIC ENTREPRENURIALISM COMBINED

CONFLICTSI RECEIVE THE SAME FINANCIAL REWARD FOR THIS PRESENTATIOIN

AS I DO FOR ALL OTHER ORTHOPAEDIC

ENTREPRENURIALISM COMBINED

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WHAT DO WE SPEND ON HEALTHCARE IN THE

UNITED STATES ?

$

US Healthcare = French Economy

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Expenditures per Capita 2006

data from WHO http://www.who.int/en/

Percent Health Care of GDP 2006

data from WHO http://www.who.int/en/

IMPENDING HIP FRACTURE CRISIS US POPULATION PYMARID

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Total Hospital and Physician Costs

13

Hip Replacement (US$)

Primary and Revision TJA Procedures Performed in the US

0

500000

1000000

1500000

2000000

2500000

2000 2005 2010 2015 2020 2025 2030

Year

Nu

mb

er o

f P

roce

du

res

Primary TJA

Revision TJA

Projections*

(down 39%)

(up 171%)

$

1994 2006

Implant Prices

Surgeon Reimbursement

Hospital Profit (down 92%)

Joint Replacement Surgery

JBJS, vol 88-A 2006

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GENERIC ORTHOPAEDIC IMPLANTS

PROVIDE AN IMMEDIATE

OPPORTUNITY FOR SURGEONS TO HELP CHANGE

OUT OF CONTROL HEALTHCARE SPENDING

ALL COMPETE WITH EACH OTHER-BUT NO LOW COST

ALTERNATIVE

Example…

$238 $98

“SCREW COMPANY” GENERIC SCREW COMPANY

HOW DO GENERIC IMPLANT COMPANIES WORK?

IMPLANT DESIGN PATENTS EXPIRE…GENERIC

COMPANIES COPY, TEST, OBTAIN FDA APPROVAL…

MANUFACTURE PRODUCTS… SELL VIRTUALLY…

IMPLEMENT REP-FREE MODEL

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Anatomy of a $1200 Screw

Sales and Marketing43.3% ($519.60)

R&D 4.4% ($52.80) Manufactering 8.1%

($97.20)

Overhead 3.4% ($40.80)

Net Margin 40.8% ($489.60)

Sales and Marketing

REPS COMMISSIONFANCY BROCHURES

PHYSICIAN TRAVEL PERCS

Example…

$238 $98

“SCREW COMPANY” GENERIC SCREW COMPANY

GENERIC SAVINGS ON DRUGSDrug Pricing

Research on Savings from Generic Drug UseGAO-12-371R, Jan 31, 2012

1999-2010 STUDY PERIOD$1 TRILLION SAVINGS

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STUDY HYPOTHESIS HYPOTHESISHIGH QUALITY GENERIC

CANNULATED SCREWS PROVIDE EQUIVILANT OUTCOMES IN THE TREATMENT OF FEMORAL NECK FRACTURES AND CERTAIN

POSTERIOR RING INJURIES OF THE PELVIS AT A LOWER COST

RENO ORTHOPAEDIC CLINIC TRAUMA FELLOWSHIP MATERIALS/METHODS

IRB APPROVAL

7.3 MM GENERIC CANNULATED SCREWS@ REGIONAL COMMUNITY TRAUMA CENTER FOR ORIF FEMORAL NECK FRACTURES AND CERTAIN PELVIC FIXATION

COMPARED DATA TO 2010 TRADITIONAL IMPLANT PATIENT POPULATION; CHART, CLINICAL VARIABLES REVIEWED, RESULTS BLINDED, DATA ANALYZED SAS VERSION 9.2 WINDOWS; LEVELS OF SIGNIFICANCE SET @ P<.05 BY UNIV. NEVADA STATS DEPT.

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TYPICAL SCREW CASES RESULTS SI SCREWS� SI- 44 PATIENTS 2010; 35 PATIENTS 2011

� 63% MALES� 40%APC, 50%LCP

NO SIG DIFFERENCES-AGE, SEX, ASA, FRACTURE PATTERNS

OUTCOME DATA SAME IN BOTH GROUPS TIME OR, COMPLICATIONS, OUTCOMES, NO IMPLANT FAILURES

IN EITHER GROUP

COST SAVINGS ANALYSIS

AVERAGE SAVINGS/CASE= $327

73% REDUCTION

$15,878/YEAR

RESULTS FEMORAL NECK SCREWS

50 PATIENTS 2010; 45 PATIENTS 2011� 70% FEMALE = BOTH GROUP

NO SIG DIFFERENCES-AGE, SEX, ASA, FRACTURE PATTERNS

OUTCOME DATA SAME IN BOTH GROUPS TIME OR, NO MAL UNIONS, FAILURES, REPEAT SURGERY OR

HOSPITAL PARAMETERS

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COST SAVINGS ANALYSIS

SAVINGS= $579/CASE

67% REDUCTION

$34,653/YEAR SAVINGS

RESULTSTOTAL COST SAVINGS FOR STUDY PERIOD $50,531.00

WITHOUT ANY CLINICAL DIFFERENCE IN HOSPITAL,

OPERATIVE, OUTCOME PARAMETERS

DISCUSSION

DISCUSSIONFIRST TRAUMA STUDY TO DOCUMENT GENERIC IMPLANT COST SAVINGS IN

CLINICAL PRACTICE

SMALL PILOT PROJECT- QUALITY GENERIC IMPLANTS WORK

IN A $3 BILLION DOLLAR TRAUMA MARKET GREAT SAVINGS POTENTIAL

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‘VALUE ADDED SERVICES’

� GENERIC IMPLANT PROGRAMS

‘VALUE ADDED SERVICES’� GERIATRIC FRACTURE PROGRAM� OWN THE BONE� COMMUNITY OUTREACH� EDUCATION� PUBLIC RELATIONS� EXPANSION SERVICES� COST CONTAINMENT-MATRIX PRICING� GENERIC IMPLANT PROGRAMS� OPERATING ROOOM EFFICIENCY� BIOLOGIC UTILIZATION PROTOLS� GATEKEEPERS

GROWTH BARRIERSCONFLICT OF INTEREST

CURRENT STUDY AUTHORS ARE STOCKHOLDERS-DATA BLINDED REVIEWERS

PATIENT PERCEPTION-LESSER IMPLANT QUALITY?

ORTHOPAEDIC SURGEONS LOVE THEIR REPS

WE HAVE A PERSONAL OBLIGATION TO BECOME

INVOLVEDBRINGS REVENUE TO HOSPITAL’S BOTTOM LINE

DEMONSTRATES PHYSICIAN COMMITMENT TO COST CONTAINMENT

SAVINGS CAN BE DIRECTED TO UNFUNDED AAOS/OTA/AOA MANDATES

WITH ACO’S- IMPROVE PHYSICIAN/INSTITUTIONAL INCOME MARGINS.

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THANK YOU