$1,900, instead of $4,000 to $7,000 retail. "That's a substantial mark-up
we've eliminated," says Dr. Botimer. "But manufacturers are still mak-
ing good money on what we're paying."
Dr. Botimer also points out that reps tend to upsell surgeons and
convince them to use costly equipment they may not need. They
also play games with expenses, such as charging extra for dispos-
ables that were negotiated into the original per-case cost.
Now that hospital employees are playing the part of reps, those
concerns are eliminated and knee replacements are much more
profitable, which is especially important in today's healthcare envi-
ronment. "It's very hard to break even on procedures, particularly
when dealing with government payers," he explains.
Health care that's not affordable to patients isn't health care, accord-
ing to Dr. Botimer. "We feel it's a moral obligation to do what we can
to reduce the cost of care without compromising quality," he adds.
"Doing away with reps eliminates an unnecessary expense and helps
us meet those goals."
Cutting out the middleman when dealing with device and instru-
ment manufacturers involves working through a series of layered and
complex issues. Some companies have long-term contracts with dis-
tributors and reps, and can't afford to sell directly to facilities, accord-
ing to Dr. Botimer. In addition, he adds, a lot of marketing is done
through relationships between reps and surgeons, and those relation-
ships end up being very expensive for hospitals and, ultimately,
patients. He also points out that numerous physicians in teaching
facilities and those who frequently publish research receive royalties
from companies. It's those vested interests that make it difficult to
remove vendors from the equation.
Dr. Botimer suggests you partner with a physician champion with
no conflicts of interest to make change happen. "It's initially more
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