With the number of joint replacement procedures growing at extraordinary rates, putting extreme pressure on already rising healthcare costs, the healthcare community must ensure that it is adequately equipped to meet the demand by preparing for the rising costs and making sure that there are enough orthopedic surgeons to handle new cases. For their part, medical device companies need to design and manufacture implants with longer life spans to avoid revision surgeries that add to healthcare costs, while exploring alternatives to traditional joint replacement procedures.Record growth in joint replacement surgeries represents a lucrative opportunity for implant makers, but with opportunity comes the responsibility to help hold down increases in healthcare costs before they overwhelm our collective ability to pay. Medical device companies are developing new materials and procedures and working with healthcare providers on preventive measures. Even so, more needs to happen to prevent joint replacement surgeries from overburdening the healthcare system.Joint replacements, which have been performed since the late 1960s, can be highly successful at relieving pain, repairing damage caused by arthritis, and helping people to function normally and remain active. According to the National Center for Health Statistics, about 43 million Americans, or nearly one in five adults, have some sort of arthritis pain. Knees, the largest joints in the body, are usually the most painful. Since obesity is also highly prevalent, cases of arthritis are beginning to onset at a much earlier age in overweight people.Number of Replacements SkyrocketingWith an aging baby-boomer generation, it should come as no surprise that the number of hip and knee replacement procedures have skyrocketed. The Nationwide Inpatient Sample (NIS) shows that primary hip replacements increased by 48%, from 153,080 procedures in 1997 to 225,900 in 2004. First-time knee replacements grew by 63% from 264,331 in 1997 to 431,485 in 2004. According to HCUPNet, 228,332 patients received total hip replacements in 2006, and 496,077 patients received total knee replacements.If these trends continue, an estimated 600,000 hip replacements and 1.4 million knee replacements will be carried out in 2015. It is estimated that by 2030, the number of knee replacements will rise to more than 3.4 million. First-time replacement procedures have been increasing equally for males and females; however, the number of procedures has increased at particularly high rates among people age 45-64 years.According to Datamonitor’s 2006 report, the US accounts for 50% and Europe 30% of the total procedures worldwide. The 2005 revenues for hip implants in the US were $2 billion and $1.4 billion in Europe, while knee implant revenues comprised $2.4 billion in the US and $774 million in Europe.Demand & Technology Drive Cost Increases With the increase in demand and improved implant materials and surgical techniques, the cost of these procedures is also increasing. According to NIS, Medicare was the major source of payment in 2004 (55.4% for primary hip replacements, 59.3% for primary knee replacements). Private insurance payments experienced a steeper increase. In 2004, the national bill for hip and knee replacements was $26 billion. Hospital cost accounted for $9.1 billion, and the amount of reimbursement was $7.2 billion (28% of hospital charges or 79% of hospital cost).Another study from Exponent, Inc. analyzed Medicare data for hip and knee replacements from 1997-2003. It was found that while procedural charges increased, reimbursements actually decreased over the study period, with higher charges observed for revisions than primary replacements. Reimbursements per procedure were 62-68% less than associated charges from primary and revision procedures. It is evident that joint replacements have the potential to be highly lucrative, but the burden on patients and our healthcare system must also be considered.Behind the Growth TrendAn aging population and increased incidence of obesity are primary causes for the increase in joint replacements. Nearly 65% of the US population is overweight, and arthritis is highly prevalent among this group. With more patients receiving joint replacements at an earlier age, there is much higher probability they will outlive their artificial joint.A recent study in Wales tracked joint replacement procedures since 2003 and found a revision rate of 1-in-75, which was considered to be a fairly good score. In the US, 40,000 knee revisions and 46,000 hip revisions were performed in 2004. However, knee revisions are expected to increase sevenfold, and hip revisions to more than double by 2030.Revision surgeries are problematic for several reasons. In addition to the extra recovery time for patients, revisions are tougher operations that take longer and cost more. There is often a reduced amount of bone to place the new implant and there is a much higher complication rate.Why Implants FailWith hip replacements, the most common problems are postoperative instability and repeated dislocations. Surgeons must consider many risk factors before the initial surgery, including age, gender, motor function disorders, dementia and prior hip surgery. The surgical approach can also affect the risk for dislocation and leg-length discrepancy, so proper pre-operative planning is a must.Components design and positioning may also contribute to instability. Dislocations are often caused by movement outside the normal range of motion, so it is important for patients to take the proper precautions following surgery. A study by the Mayo Clinic showed that in the case of repeated dislocations, the hospital fees for treatment and revision surgery end up costing, on average, 148% of the cost of the initial replacement. The decision to undergo a revision surgery is typically made based on repeated dislocations and the patient’s health. Patients that have undergone previous hip surgeries or have poor abductor muscles are at greater risk for failed revisions.Revisions of knee replacements may be required when patients experience infection, osteolysis, implant loosening or misalignment, knee injury or chronic progressive joint disease. Decisions to undergo revisions are made based on previous knee surgeries, current health and radiographic examinations. Patients with poor bone quality, unresolved infection, peripheral vascular disease or poor quadriceps muscles or extensor tendons are at greater risk for a failed revision.Preventive MeasuresWith the unprecedented growth in replacement procedures, measures must be taken to prevent this phenomenon from overwhelming our healthcare system. This can be accomplished through better preventive care, alternatives to total replacements, and by ensuring that primary replacements are successful. Reducing obesity and treating arthritis at earlier stages will help reduce the numbers of procedures. In addition, many have called for a national joint replacement registry such as those in Australia, Great Britain, Norway, Denmark, and Sweden, which track high failure rates associated with some joint replacement procedures.Alternative procedures are available that have improved dramatically over the past 10 years. For example, partial replacements are less-invasive, with smaller scars and shorter healing times because only the diseased compartments are replaced. Minimally invasive procedures are available for total replacements in some patients. There are also new options available for women needing total knee replacement, known as “gender-specific” knees that are slimmer and contoured to more closely imitate the female anatomy. Hip resurfacing is another procedure gaining in popularity because it conserves more bone than a traditional total hip replacement. This type of implant will last longer than a traditional hip replacement.New biomaterials and component designs also increase the lifespan of implants, and computer-assisted surgery can improve the success of joint replacement by allowing more accurate and precise implant alignment. Several studies have shown this type of procedure to be more cost-effective by preventing the need for revision.Looking AheadFor medical device companies, the record growth in joint replacement procedures presents a lucrative opportunity. However, manufacturers need to work with the medical community to help ease the burden of this epidemic by increasing the success and longevity of their implants and exploring alternatives to the traditional joint replacement procedures.Undoubtedly, national joint replacement registries have proven useful in other countries. The medical community needs to demand that a registry be put in place in the United States, and it needs to do a better job of educating society on prevention. It is important that the medical community, including device companies, come together with a plan for preventing the potential burden this overwhelming surgical load could have before it takes a toll on our healthcare system.
It’s no secret that healthcare fraud accounts for an estimated 100 billion dollars a year in the United States alone, and it’s increasingly a reason that health care costs continue to rise. Unnecessary and fraudulent treatments are being submitted to payer organizations by organized crime and con artists have become big business in North America today. Increasingly, health insurance organizations are looking at new ways to detect, investigate and prosecute anyone submitting fraudulent health care claims.An independent review organization plays an important role in helping healthcare fraud special investigative units investigate and determine whether claims are legitimate, whether chart notes support a legitimate case and whether medical necessity is associated with a case.A doctor from independent review organization can quickly look at the charts involved in a claim and decide whether been documents were fraudulently submitted, whether the medical facts in the chart fit the claim and whether there’s any up-coding or other tricks used by fraudulent claims submitters in order to get paid for treatments that weren’t actually performed or even necessary.Healthcare fraud is a problem in North America, yet gets very little attention in the news media. It is a problem that needs to be solved in order to reduce the cost of healthcare for all of us. Independent review organizations are playing an increasingly important role in reducing healthcare fraud by helping fraud special investigative units close fraud investigations and provide important insight about which cases should be paid and which shouldn’t.
Creating awareness for your healthcare facility, especially with little or no budget, can be a daunting task. New competitors, a lack of prior marketing, a poor reputation in the past and lack of funds are all reasons why your facility may be experiencing a decline in patients or a lack of growth.While a difficult task for any business, creating awareness for a healthcare facility can be especially daunting because there is so much competition out there. Here are a few inexpensive ways to let people know you’re out there and what you stand for.1. Write articles or provide tips to local homeowners’ associations.2. Provide educational information for small businesses in the community by contributing to your local chamber of commerce. Think workplace safety, workman’s comp, etc.3. Publish articles or inexpensive advertorials in your local community paper.4. Partner with realtors in the area and target new families moving into the community. Make sure they know where you are, help them find a local PCP, etc. Be a source for referrals. This can be as easy as creating a handout they give to new families when they buy a house.5. Similar to how you partner with realtors to introduce yourself to new families in the area, you can also joint venture with apartment complexes and building management companies. Both residential and commercial management companies provide welcome packets for new tenants. Why not include some information about your facility and how to find you? And the great thing about this approach is that once it’s done, you don’t have to worry about doing it again. It’s an easy system to put in place for ongoing marketing.6. In addition to the welcome packets, you can publish “health tips” articles in building association newsletters, too. Both residential and commercial complexes usually publish a newsletter for their tenants and are always looking for ways to add value to the publication. They’re always looking for content. Help them out!7. Work with your local newspaper to add a “health” section to the newspaper’s Web site. Make sure the paper knows you’re available for interviews or questions on any healthcare related topics that come up. You can also post a calendar of events, etc.8. Offer free or low-cost seminars to educate the public. Participating physicians may conduct these.9. Can you do a joint venture with someone in the community? Be creative. For example, maybe the local kids’ sports team. You can be the official sponsor and provide free tips in their newsletter or have staff people at the games for parents to ask questions.10. Remember, people like free things. What can you give away for free? A free report or free consultation? A free blood pressure check? Give this free thing away in all your communication pieces.
When you are not well or healthy, you should seek healthcare advice from doctors or health experts. Do your homework by identifying different health-care services and how to get health insurance to help pay for health care. This will help you financially and mentally as well.If you are feeling not well you should go to see a doctor or health experts. Going to see a doctor is not going to assurance that you will get well. You must to know what to ask and follow the directions and prescription the doctor gives you. In addition, you required good amount of money to pay for these services. It is very difficult to pay for good healthcare coverage from your pocket. That is the main purpose for the discussion on health insurance.Try to understand the importance of seeking healthcare advice when needed. Many people do not go to the doctor or health experts because of difficulty, money, and panic. These are all justifiable reasons for avoiding a doctor’s clinic. Putting of seeing a doctor can cause superior difficulty, money, and panic.Search available healthcare options in your area. Most insurance companies want that people see a primary care physician before going to an expert any time they want, but they will most likely have to pay for the appointment themselves. Search on internet or ask your friends or go through the yellow pages and look up different types of healthcare providers. You can find a list of physicians by specialty in your area or nearby. Most people will go to an internal medicine doctor or family practice doctor for basic healthcare such as colds, flu, cough, cuts, etc. again, people who have health insurance would pick their doctor from a list that the insurance companies provide.Search various healthcare options available in your area. The clinic where your doctor sits is where you go for basic medical checkups. Search whether there are free medical checkups available in the hospital and where it is located. Most people get health insurance through their company. A person who is not entitled for health insurance from any of these sources can pay for health insurance independently through an insurance company. Depending on the medical coverage, you may have to pay a certain percentage of the total medical expenses, a flat fee for each visit to the doctor or hospitals, or may pay nothing.Copyright © Nick Mutt, All Rights Reserved. If you want to use this article on your website or in your ezine, make all the URL’s (links) active.