Changing Physician Behavior to be More Cost Conscious in Distal Radius Fracture Surgical Management: A Survey Study

Abstract

Objectives:
To evaluate six surgeons’ overall experience using cost-effective implants compared to the implants they typically use.
Design:
Cross-sectional Survey
Setting:
A Metropolitan Healthcare System
Participants:
Six surgeons who operatively treat distal radius fractures regularly.
Intervention:
Surgeons were asked to alternate implant (brand name vs. generic) use in DRF fixation each month. They were then sent a 10-question survey to evaluate their experience with the generic implants. Most questions were rated on a 1-10 Likert scale (1=worst outcome, 10=best outcome).
Main Outcome Measurements:
Ease of Use and Continued Generic Implant Use
Results:
All six surgeons completed the survey (100% response rate). Most surgeons completed a hand surgery fellowship (83.3%) and performed their cases in an ambulatory surgery center (83.3%). The average rating for ease of use and how intuitive the system was were 8.8±2.2 and 8.5±1.7. Most surgeons felt that generic implants added little or no extra time to the procedure (4.5±1.0, with 5 being neutral). Most in this group would use generic implants again and recommend them to colleagues (8.2±2.9, 8.0±3.2, respectively).
Conclusions:
Implant preference is often driven by exposure during residency and fellowship and is minimally evidence-based by comparison. In many instances there is a belief that the value lies in the technology when, in fact, patient selection, surgical technique and post-operative management are more important in determining patient outcome. As cost containment strategies are developed and implemented, we recommend they come from physician leadership, and not top-down administrative mandates.
Key Words:
Surgeon Behavior, Satisfaction Survey, Implant Cost, Cost Containment Strategy, Generic Implants, Distal Radius Fracture
Level of Evidence:
Level V