pare pre-op paperwork to managing the facility's supply of implants.
"But some facilities and administrators are recognizing that they don't
need or want the support," says Christopher D. Provines, MBA, the
CEO of Value Vantage Partners and an adjunct professor of supply
chain management and marketing sciences at Rutgers Business
School in Newark, N.J. "So they're trying to unbundle those services
and separate the implant from the rest of the package."
Typically, the bulk of vendor support is focused in the OR, where
the rep gives the surgeon instruction on implanting the device. It's an
important role, says Mr. Provines, but one that may be better filled by
surgical techs or assistants who don't benefit financially from their
relationships with surgeons.
Since different total joint implants tend to result in similar patient out-
comes, the choice of which one to use often comes down to surgeon
preference. That preference can be at least partially driven by the doc's
relationship with the vendor and its rep, says Mr. Provines. And if that
rep has a flashy new implant available, he may upsell it to the surgeon
even if it offers little advantage over cheaper alternatives.
"From a purchasing standpoint, you realize more objective buying
by going repless, because it's less about relationships and more about
the quality, price and innovation," he says.
Those benefits are a few reasons why the Santa Rosa (Calif.)
Memorial Hospital recently revamped its total joint program with the
hope of eventually moving to a repless model. Though the move away
from vendor reps is only one part of the program's overhaul, David
Ziolkowski, MHA, chief operating officer of St. Joseph Health–
Sonoma County, which oversees Santa Rosa, notes that administra-
tion sees it as a way to get implants at a low cost, while also better
regulating which devices are used in the OR.
"There's a general concern that as reps develop relationships with
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