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Mr. Relph.
Wayne County Hospital now does the majority of its total joint cases using the
rep-less model, though some complex procedures still require assistance from
implant manufacturers. "We don't do a lot of revision work, so when we do, it's
good to have reps involved," says Mr. Relph. "If we need a specific part or
implantable device that we don't carry in inventory, we want them in the room."
Down the rep-less path
Gary D. Botimer, MD, chair of orthopedic surgery at Loma Linda University
School of Medicine and an orthopedic surgeon at Loma Linda University
Surgery Center in Richmond, Va., says her facility relies heavily on implant
vendors when they have a problem with a piece of equipment, when they
bring on a new
surgeon, or when they need a device very quickly. The close relationships
the center has with vendors also open up opportunities to negotiate on
pricing and service contracts.
Vendors also provide a valuable safety net, of sorts. "If you've chosen to
go rep-less, where is the relationship if something breaks down?" says Ms.
O'Brien. "If there's an urgent need, or if you're in the OR and something's
malfunctioning, you're an island. It's you against the world."
• Cost considerations. The expense to train OR staff to assist surgeons
can be significant and may eat into potential cost savings the rep-less
model provides, says Dr. Botimer. Also, performing procedures without the
aid of an experienced rep could extend case times, especially early on.
Lastly, if going rep-less causes any spikes in negative patient outcomes, the
resulting costs would likely offset — or even surpass — any savings on the
implants themselves.
— Bill Donahue
