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Spine Surgeons Waste Millions On Opened, Unused Implant Devices

Joe Cantlupe, for HealthLeaders Media, November 10, 2011

Talk to enough physicians and hospital execs, and you will hear a term they use to refer to colleagues deviating from their peers, whether they aren't doing enough to improve patient care, are falling behind in their work, or are spending too much: outliers.

"No one wants to be an outlier," Kevin McGuire, MD, MS, chief of the orthopedic spine service at Beth Israel Deaconess Medical Center in Boston and assistant professor of orthopedic surgery at Harvard Medical School, told HealthLeaders Media.

In spine care, McGuire found a lot of outliers, surgeons wasting money by wasting medical implant devices. McGuire admits he was once an outlier too.

Here's how they got rid of the waste. Several years ago, McGuire and other physicians at Beth Israel Deaconess examined how much they used and spent, questioning why anything was discarded improperly, down to the smallest screw. They also analyzed steps that could be taken to improve implant surgeries. The hospital initiated a Lean system to improve value, reflective of the Toyota Production System management process. The medical professionals carried the process one step farther, cataloging as much as they could and precisely reviewing use of implant materials through peer-to-peer evaluations, McGuire says.

By implementing a few process changes, the spine surgeons at Beth Israel Deaconess cut in half the number of procedures that produced waste, dramatically lowering costs. Before launching a simple awareness program about this issue, the monthly cost linked to the surgical waste was about $17,680. Afterward, it dropped to $5,876.

Extrapolating from the amount of waste these physicians uncovered at their hospital, they believe that spine surgeons across the country could save more than $126 million in surgery costs for implants each year by conducting an awareness program. They presented their study to the 26th annual meeting of the North American Spine Society in Chicago last week.

"We were initially surprised at the size of the problem," says McGuire. "Most of the driver of that was implant waste. That's what drove the project forward, identification that there was a problem."

"We are the drivers of the cost; we need to be part of the solution," McGuire opines. "Physicians are responsible for ordering a significant amount of material."

Each year, more than 600,000 spinal surgeries are performed in the U.S. Medical implants require an abundance of costly equipment such as medical screws, rods, cross links, and interbody cages.

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1 comments on "Spine Surgeons Waste Millions On Opened, Unused Implant Devices"


Apurv Gupta (11/10/2011 at 5:07 PM)
Really enjoyed reading this article, which reveals a highly successful deployment of a "performance improvement project". A similar "performance improvement" approach can work in improving quality, mitigating risk, and improving patient safety. Just to make the elements clear to all leaders, I'm posting my blog on this topic below. The article identifies the following "performance improvement tactics" that should be integral components of all improvement projects: ** Examined how much they used and spent (review and monitor data) ** Questioned why each device was being being used (ask why five times) ** Studied reasons for wastage (undertake root cause analysis) ** Asked surgeons, operating room personnel, industry representatives, and nurses to help them identify waste (seek multi-disciplinary input) ** Compiled lists of who had been wasting more instruments than others (create profiles) ** Shared lists [of waste generators] with each other (create report cards) ** Awareness campaign (educate) ** Physician leadership prompted change (get support from leadership) The key behavioral drivers that project leader, Dr. Kevin McGuire, Chief of Orthopedic Surgery, identified are "physicians are competitive in nature" and "no one wants to be an outlier". Understanding these drivers is key to understanding some of the performance improvement tools and how to deploy them effectively.