Kick Women Off Soccer Field? // and More!

No Soccer for Women? … Surgeon Preferences Driving High Costs … Explosion of Payment Models Coming … QOL Measures in Osteoarthritis and RA

Women…Off the Soccer Field!

A veteran sports medicine specialist has seen so many injured female soccer players that he is wondering, “Should females be playing soccer?” He tells OTW, “Look, my daughter is a talented, devoted soccer player, and I’ve always cheered her on. But I have to wonder what’s going on with so many female soccer players being injured…it’s at unprecedented levels. There’s still a lot we don’t understand about the mechanism of injury in the knee, and particularly the ACL. And there is more pressure on our treatment protocols—anything less than perfect is unacceptable. No one wants to have a young mother pushing a stroller and limping.”

“These are largely noncontact injuries; a typical patient is a 17-year-old girl who is accelerating on the field and pivoting vigorously…then her knee gives out. If you study the average woman athlete compared to the average male of the same age doing the same sport, you find that in a simple horizontal leap test, the male’s trunk stays centered on his lower body when he lands, while with females as the lower body stops the moving trunk keeps moving, thus putting a lot of torque on the knee. Unfortunately, no one can even say that working on trunk strength has changed much of anything for these athletes. I think we are in denial as to what all of this means. Are we sacrificing our daughters’ future for the glory of sport? I think we need to all take a deep breath and have an honest dialogue about the risks involved here. If a young boy is considering playing football, the family has a discussion about that…not the case if a young girl wants to play soccer. I think a change is coming, however.”

Surgeon Preferences Driving High Costs

Kevin Bozic, M.D., M.B.A. has just published some enlightening work on the cost of hip and knee replacement. Discussing his study, “Variability in Costs Associated with Total Hip and Knee Replacement Implants, ” Dr. Bozic tells OTW, “There are a number of policies aimed at controlling costs associated with hip and knee replacements, and several that are specifically focused minimizing non valued added costs. For example, you have the same procedure performed at three different hospitals by three different surgeons; you have roughly the same patient population and the same outcome—but there is a threefold difference in cost. What we found was that the implants are the major driver of the variability in cost…with little evidence that the implant is the primary driver of outcome.”

“Our goal was to understand what factors drive this variability. First, we found a significant variability in cost of implants, even after controlling for things like patient age (you might think that a younger person would have a more expensive implant, but that was not the case), hospital size (you may think that a larger hospital would have better pricing, but that wasn’t the case), procedure volume (discounts for volume—not the case). And interestingly, hospitals that had fewer vendors (a common strategy employed by hospital purchasing groups to control implant costs) didn’t have better pricing than hospitals that didn’t. Indeed, we found that very little of the variability can be explained by patient, hospital, or market factors. We concluded that a majority of the variability was the result of surgeon preferences…and that ultimately hospitals, surgeons, and device companies must be aligned around the delivery of high value care which would produce the best outcomes at the lowest cost.”

QOL Measures in Osteoarthritis and RA

Michael Carter, M.D. is a transitional resident at Indiana University in Indianapolis, and will be starting a residency in radiology at the University of Michigan in July 2013. His recent study, “Total Shoulder Arthroplasty on Generic and Shoulder-specific Health-related Quality of Life Measures, ” has shed light on the physical and mental outcomes of total shoulder arthroplasty. Dr. Carter tells OTW, “Quality of life measures are huge in osteoarthritis and autoimmune diseases like rheumatoid arthritis…they are the way you determine if a treatment is working. Using these measures helps orthopedic surgeons keep track of patient outcomes. The use of global measures, such as the SF-36, helps to show effectiveness, which is increasingly important to patients and payers of health care.”

“We did a full systematic review of all the measures people are using…what scales, what results were obtained when using certain scales. We looked at over 40 different outcome measures. When looking at outcome scales and analyzing the data we found the most dramatic effect of total shoulder arthroplasty was for pain relief; improvement in activities of daily living were also significant. We did not have sufficient data to establish the effect on mental status, however. In the future we would like to pursue other studies with other global measures that address quality of life.”

Steven Teitelbaum, M.D. Wins Mentorship Award

The 2012 Gideon A. Rodan Excellence in Mentorship Award has gone to Steven Teitelbaum, M.D. of the Washington University School of Medicine. The Gideon A. Rodan Excellence in Mentorship Award is given in recognition of outstanding support provided by a senior scientist who has helped promote the independent careers of young investigators in bone and mineral metabolism. Dr. Teitelbaum is the Wilma and Roswell Messing Professor of Pathology and Immunology and Medicine at Washington University School of Medicine where he is a member of the Division of Bone and Mineral Diseases. Dr. Teitelbaum served as President of the American Society for Bone and Mineral Research and of the Federation of American Societies of Experimental Biology. He participated in efforts which led to the doubling of the National Institutes of Health (NIH) budget and liberalizing stem cell research in the state of Missouri. Dr. Teitelbaum has trained more than 70 graduate students and post-doctoral fellows, many of whom have become leaders in bone and mineral research and hold distinguished academic and industrial positions. His research focuses on the osteoclast.

Explosion of Payment Models Coming

Chad Mather, M.D. is an attending orthopedic surgeon at Duke University and is a former American Academy of Orthopaedic Surgeons Washington Health Policy Fellow. He tells OTW, “The November election does create uncertainty in the health care landscape. As such, many providers are trying to place their efforts in areas that are unlikely to change. One of those areas is in payment reform. When I was on Capitol Hill recently, it was clear that there is bipartisan support for dramatic changes to traditional fee-for-service reimbursement. But there is also strong support for intimate physician involvement in development of new models. And we are already seeing this—not only from government payers, but also private insurers. It may be a fee for service type system, with value based payment adjustments. It will also involve episodic payments which involve a greater shift in financial risk to the provider from the insurer. We probably can’t do away with fee for service completely, as a recent Health Affairs article has suggested, but the variety and scope of payment models will explode over the next four years no matter which party is in power. Many providers are intrigued by this because a shifted financial risk can be positive—if we can figure out how to deliver quality care at a lower cost. You can prepare now by examining your own delivery landscape and look for opportunities to coordinate care and cut waste-unfortunately there isn't a one-size-fits-all strategy as each individual system and episode proses different challenges and opportunities. My prediction for November? I like to follow historic trends and the approval rating of the incumbent: above 50% will mean reelection and below that we might see a new administration.”

Blue Belt Technologies Wins Innovation Award

Blue Belt Technologies, Inc., whose U.S. headquarters is in Pittsburgh, Pennsylvania, has won the 2012 Global Orthopedic Surgery Technology Innovation Award from Frost & Sullivan. The company has developed the Navio PFS System, the next generation of “smart” instruments providing precise robotic control to physicians. Blue Belt is specifically targeting unicondylar knee surgery as their first application for the Navio PFS System. The following criteria were used to benchmark Blue Belt Technologies’ performance against key competitors: Uniqueness of Technology, Impact on New Products/Applications, Impact on Functionality, Impact on Customer Value, and Relevance of Innovation to Industry.