Scott D. Boden, MD, Chairman, Department of Orthopaedics, Emory University School of Medicine, VP of Business Innovation, Emory Healthcare
Orthopaedic surgery has been driven by technology the last 40 years as much or more than most subspecialties. Historically, new technology was able to facilitate entirely new or substantially better treatments for musculoskeletal problems and this new technology was able to warrant a premium price. More recently that “new technology driving increased pricing” paradigm is changing and the transition to a value-driven healthcare economy may be slowing the pace of innovation a bit in Orthopaedics.
Current innovations will need to solve unsolved problems or offer solutions to existing problems that deliver better outcomes and lower overall cost. Hospitals are under increasing pressure to do more with less and will find it increasingly difficult to justify incremental pricing for new technology that is just slightly better. Orthopaedic device companies are increasingly looking at episodes of care and designing technology options and pricing strategies that increase predictability of cost. Those that can lower the cost of care with their new technology are likely to be the most successful. The increased pricing transparency to consumers will only accelerate this new requirement.
"Current innovations will need to solve unsolved problems or offer solutions to existing problems that deliver better outcomes and lower overall cost"
Some hospitals and practices are using novel technology such as robots for market distinction. However, the value proposition for this expensive new technology is yet to be fully documented with respect to improved outcomes and decreased episodic cost. That’s not to say that the value isn’t there, but the business use cases have yet to be fully developed and validated across a spectrum of care delivery settings. Other examples of questionable long-term viability include biologics and cell-based products that are emotionally attractive to physicians and patients alike, but have not undergone the rigorous burden of proof requirement that other technologies have done.
As a general observation, medicine has not taken maximal advantage of technology, cloud-based computing, internet of things, etc to improve quality, lower cost, and improve user experience compared to many other industries. Hence, there is great opportunity to better leverage healthcare IT solutions to improve quality, decrease cost, and restore the joy of practice for providers. This should be a critical focus and litmus test for innovations in the orthopaedic space. Those that can accomplish all three goals are likely to have the greatest success. Achieving these multi-domain technology innovations will likely require broader and multi-party development partnerships that may stretch beyond the stand-alone medical device or pharma manufacturer.
The one absolute certainty about healthcare at this time is that the future paradigm remains absolutely uncertain. Regardless of payment models, speed of transition to value-based care, and political changes in Washington, innovations in medicine will have to satisfy additional criteria besides pure novelty and iterational improvement - and particularly in a device/technology dependent specialty like Orthopaedics. There are supply chain management and inventory opportunities, transitions to outpatient surgery, and increased episodic or bundled pricing strategies that would benefit from technology and advances designed for those changes. In the end, improving quality, lowering cost, and improving the patient and provider experience will lead to the most successful advances in the coming years.