Determining Resource Utilization Levels in Total and Reverse Shoulder Arthroplasty

In standard total shoulder arthroplasty (TSA), the shoulder’s ball and socket joint is replaced with a prosthesis made of polyethylene and metal elements¹ whereas in reverse shoulder arthroplasty (RSA), the location of the new ball and socket are on the distal side of the shoulder, in a reversed position.² A Journal of Shoulder and Elbow Surgery (JSES) article, “Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015,”³ cites data showing that demand for upper extremity arthroplasty is greater than the growth in demand for hip and knee arthroplasty. The authors’ report estimated procedure annual growth rates by procedure type (Chart 1).

The Significance of Procedure Growth
Procedure growth is important, but payers are searching for even more effective and sophisticated methods to reduce healthcare spending.⁵ The JSES authors noted, for example, that fast growth in the number of revisions for upper extremities as seen in Chart 1 is troubling because revision surgery is more complex than primary arthroplasty.⁶ In a recently published article, “Measurement of Resource Utilization for Total and Reverse Shoulder Arthroplasty,”⁷ the authors present data about the total cost of care, making direct comparisons of the resources utilized over a 90-day period of care for both TSA and RSA patients.

Why Does Resource Utilization Matter?
Standardization is a method to reduce cost and improve outcomes.8 Atul Gawande, M.D., author of “The Checklist Manifesto: How to Get Things Right,” contends that standardized operating methods are good for healthcare services.⁹ When Gawande was looking for a surgeon to perform a total knee replacement on his mother, he selected R. John Wright, M.D., an associate orthopedic surgeon at Harvard Medical School. As Gawande explained, “[Wright] has led what is now a decade-long experiment in standardizing joint-replacement surgery, by formulating a single default way of doing knee replacements.” By using a standardized approach, Wright has achieved new efficiencies, cost savings, and improved patient outcomes. In an interview with the American Academy of Orthopaedic Surgeons,¹⁰ Wright said, “customization should be 5 percent, not 95 percent, of what we do.”

The authors of “Measurement of Resource Utilization for Total and Reverse Shoulder Arthroplasty” take Wright’s notion a step further, bringing it out of the operating room (OR) and into the areas of pre-op and post-op care. Not only do they compare pre-op holding time, OR time, and anesthesia time (Chart 2) for TSA and RSA, they also measure post-op medications and surgical supplies used after the two procedures as well as the average number of skilled nursing and physical therapy visits needed by patients after TSA and RSA (Chart 3).

Data Prevails Again
It is critical for orthopedics device manufacturers to understand the trends that guide the process of healthcare provider and physician decision making. RSA and TSA are high cost procedures (estimated use of primary shoulder arthroplasty increased to 67,184 cases in 201113), and surely will come under hospital scrutiny. Do you know the utilization data and outcomes associated with the procedures your device serves? 

References

1. Wilcox R, Arslanian L, Millet P. Rehabilitation following total shoulder arthroplasty. The Journal of Orthopaedic and Sports Physical Therapy [serial online]. December 2005;35(12):821-836
2. Ibid
3. Day, J., et. al, J Shoulder Elbow Surg (2010) 19, 1115-1120
4. Ibid
5. Kolata, G. What are a hospital’s costs? Utah system is trying to learn http://www.nytimes.com/2015/09/08/heath/what-are-a-hospitals-costs-utah-system-is-trying-to-learn.html?_r=0
6. Op.cit 3
7. Am J Orthop (Belle Mead NJ). 2015 Oct;44(10):446-52
8. http://atulgawande.com/book/the-checklist-manifesto/
9. http://www.aaos.org/news/aaosnow/nov12/clinical9.asp
10. Ibid
11. Op cit. 7
12. Op cit. 7
13. J Shoulder Elbow Surg (2014) 23, 1905-1912

Editor’s note: Readers are invited to submit market data and trend questions to Maria Shepherd. Periodically, selected questions will be presented in this column with answers from Maria. Send your questions to the email in her bio (below).

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Maria Shepherd has 20 years of leadership experience in medical device/life-science marketing in small startups and top-tier companies. Following a career that included roles as vice president of marketing for Oridion Medical (a company acquired by Covidien, which is now Medtronic), director of marketing for Philips Medical and senior management roles at Boston Scientific Corp., she founded Data Decision Group. Shepherd recently was appointed to the board of the ALIGO Healthcare Investment Committee. She can be reached at (617) 548-9892, [email protected], www.ddecisiongroup.com, or followed on Twitter @MedTechResearch