Letter to the Editor: Clinical Faceoff: How Will Recent Price Transparency Policies Impact Orthopaedic Surgery and its Patients?

To the Editor,

I enjoyed reading the latest Clinical Faceoff column on price transparency [1]. I’m a big advocate for understanding value in healthcare, which can be defined as the benefit of an intervention to the patient divided by the total cost of the intervention (including preoperative assessment, the direct costs of the intervention, costs of follow-up care, and the costs of complications and revisions).

Price transparency, as Dr. Bozic points out in the column, is just one of the elements of the value equation, but it is an important one. Indeed, one of the major elements in price is the cost of the implants, which is perhaps the least transparent of the elements of value. The actual selling price is often negotiated confidentially between medical centers and the company so that the actual price is unknown to the rest of the world. It appears that companies “make deals” specific to the medical center so that the price of an implant at one hospital is substantially below the price at another. The basis for these “deals” can be left to one’s imagination. But because the basis for these discounts is unknown, the playing field is uneven.

I would be interested to know your thoughts on implant price transparency and how an even playing field might be achieved. Without this information, it seems that certain medical centers would be disadvantaged in the increasingly competitive world in which we live.

Thanks again for all you’ve contributed to our understanding of value.