get at least a 20% savings, says Mr. Uba. In the last 3 years of using
bundled payments, Mr. Uba figures Excelsior has saved payers about
$4 million.
2. Invest in patient-specific instruments
During total knee replacements, Keith Berend, MD, an orthopedic sur-
geon at Joint Implant Surgeons in New Albany, Ohio, favors using
patient-specific instruments (PSIs) over a computer-navigation system
that guides the surgical process.
With this method, an MRI scan is used to create disposable molds
that fit to a patient's femur and tibia with a slot to guide the surgeon's
cuts on those bones. Because the molds are based on a patient's anato-
my, the PSI method approaches the same surgical accuracy in placing
implants that the computer navigation method does, while significantly
reducing the time it takes to perform the operation.
In a study he co-authored in the Journal of Surgical Orthopaedic
Advances, Dr. Berend found that using PSI saved 28 minutes of OR
time compared to the conventional method of total knee replacement.
Compared to computer navigation, PSI saved a whopping 67 minutes.
When that time savings gets multiplied over dozens, hundreds or even
thousands of cases, the overall cost reduction is clear.
The PSI method also reduces OR clutter. Because a pre-op MRI
allows for predetermined trial sizes and a custom cutting jig, only one
operative tray needs to be prepared for the procedure, as opposed to
conventional and computer-navigation methods that require 6 or 7
trays. Dr. Berend's study estimates the processing cost of each tray at
about $58. That saves nearly $300 on each case.
If custom tools that fit the patient have been shown to reduce costs, why
not go one step further and use custom implants? Wouldn't a perfectly
molded implant make surgery breeze by even faster? Not quite, according
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