Surgeon at Cleveland Clinic’s Fairview Hospital says he’s leaving over cost-cutting efforts (Cleveland.com)
An orthopedic surgeon at Cleveland Clinic’s Fairview Hospital is removing his practice from the Clinic because leadership is requiring him to use an implant he says would jeopardize care in the name of cutting costs.
Dr. Raymond L. Horwood wrote a letter recently informing his patients that the Clinic’s decision to limit implant options is prompting him to take his practice to St. John Medical Center, a University Hospitals facility in Westlake.
“Dr. Horwood does not feel in good conscience that he can jeopardize his patients by switching to an unfamiliar implant system simply to save money for the hospital,” the letter said.
The letter explained that the Clinic, as part of a broader cost-cutting effort, has sought to limit implants used in joint replacements to two vendors – Stryker Corp. and Zimmer Holdings. Horwood’s letter said that he used DePuy J&J implants for 28 years and experienced “excellent clinical outcomes.”
His decision to leave the Clinic’s network highlights tensions over the organization’s efforts to standardize surgical procedures and transform the way it delivers care. Hospital executives said the effort is meant to generate more consistent results, improve quality, and cut costs.
Dr. Brian Donley, the Clinic’s chief of staff, acknowledged the process to standardize procedures can lead to conflicts among physicians.
“It doesn’t always make everyone happy,” Donley said. “There is a tremendous amount of change going on in health care as we work to drive quality, but do it in a more affordable way.”
Horwood, Fairview Hospital’s physician of the year in 2011, works for Orthopaedic Associates but houses his practice at Fairview. He declined through an administrative assistant in his office to be interviewed. His letter stated he is moving to St. John Medical Center effective Oct. 1. St. John is jointly owned by University Hospitals and Sisters of Charity Health System; UH recently announced a deal to take full ownership of the hospital.
Spurred by the Affordable Care Act, the Clinic and other hospitals have instituted sweeping changes to become more efficient and compensate for reductions in reimbursements.
Clinic physicians have created so-called “care paths” to establish protocols for dozens of surgeries and other procedures. Part of the effort involves standardizing the equipment used to perform particular operations.
Donley, himself an orthopedic surgeon, said the decision over which implants to use in hip and knee replacements was made by physicians who perform those surgeries in the Clinic’s facilities.
“No one is excluded from the opportunity to be involved,” he said. “We evaluate the safety and quality of all the options, and our physicians group determines which ones are acceptable.”
He said the Clinic cannot allow physicians to deviate from the protocols because it would undermine efforts to lower costs and generate more consistent outcomes.
While standardization might make care more efficient, it can also alienate physicians accustomed to using particular tools or methods. In the realm of orthopedics, an implant is as integral to a surgeon as a brand of instrument is to a musician.
Stryker, Zimmer and DePuy are among the five largest manufacturers of implants used in joint replacements and other surgeries. Each company has faced a variety of lawsuits in recent years, some of which have resulted in settlements worth more than $1 billion.
In November of 2014, Stryker agreed to pay $1.43 billion to settle thousands of lawsuits from patients who had to have surgery to remove problematic hip implants.
Zimmer also faced a burst of lawsuits over a hip implant and announced that it expected to pay at least $260 million related to those claims in 2012.
Meanwhile, DePuy and Johnson & Johnson agreed to pay at least $2.5 billion in 2013 to settle claims over allegedly defective all-metal hip implants.
In his letter, Horwood did not directly express concerns about the quality of the Stryker and Zimmer products. But he indicated switching to those products from DePuy could undermine the effectiveness of his care.
His letter ended, “Dr. Horwood would be happy to discuss this further should you have any questions regarding the Cleveland Clinic purchasing initiative or his decision to put patients first.”
A Clinic spokeswoman noted that several of the physicians who work within Horwood’s independent doctor’s group are staying at Fairview Hospital.
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