Newtown, CT – May 22, 2015
Imagined dialogue between an orthopedic surgeon and a patient.
Doctor – "Do you mind if the sales representative for the manufacturer of the new knee I'm going to put in is present during your operation?"
Patient – "Why does he need to be there? Is the representative trained in medical procedures?"
Doctor – "No, the representative is not a clinician, but might be helpful in providing technical advice on the new knee if I need it"
Patient – "You're telling me that you need a representative of the manufacturer of my new knee joint to be there so he can help you if you run into a problem or have a technical question? Yikes."
* * * * *
In most operating rooms across the country, unbeknownst to the patient, a stranger is watching. The stranger is not a clinician, not a member of the hospital staff or of the surgeon's practice. The stranger works for the device manufacturer and there, presumptively, to offer technical advice on the implant if questions arise. Of course, the representative is paid for being there and that cost, blended in with other sales, general and administrative costs, can represent up to 40% or more of the device price. In other words, the patient is paying for the privilege of having a stranger watch the operation, and if the dialogue above actually took place, sales reps would be banned from all operating rooms in a few weeks. After all, it doesn't exactly inspire confidence to know that the surgeon might need some on-the-spot training or help with the implant.
What this means to you – Every year there are millions of procedures that require implantable devices. In the US (and only in the US), sales representatives of the device manufacturer are paid to be by the surgeon's side, adding billions of dollars to the total cost of these devices without any added value. There are alternatives, with some hospitals and vendors offering "rep-less" sales models, but the industry stranglehold by a few very powerful vendors has so far choked off the reform effort. New payment models, in particular bundled payments, are creating an impetus to reduce waste, improve the management of the supply chain, and take out low value services. As such, the "rep-less" model will inevitably grow, but in this case, irrespective of payment models, it seems simple and common decency to enforce a simple rule of disclosure. If someone other than hospital or physician practice staff is present in the operating room, the hospital and the surgeon should have the obligation to disclose it and ask the patient for consent. Transparency isn't just about a handful of metrics that are published (most of which can't even distinguish provider performance as evidenced by the new and mostly useless rankings released by US News & World Report), but about disclosure to patients…full disclosure. Anything less is like allowing a peeping Tom to roam freely from OR to OR.