Patients generally trust their physicians to use the product that is best for their procedure.For implants used in spinal fusions, however, there are times when a surgeon may not have access to specific products because the hospital may not carry it in their formulary, or list of readily available products.
When a hospital has a financial interest
Have you ever thought about how specific medical devices end up in your surgeon's hands?
In an effort to cut costs, some hospitals have gone to a 1- or 2-vendor system, whereby a device company discounts their products and in return the hospital agrees to limit the number of vendors for that product. It is a simple volume for price arrangement. In many instances, the products are all comparable and this does not affect patient care.
Where patient care can be compromised, however, is if the hospital limits access to technologies that have variability in performance. If this happens, hospital choices may mean that patients may not have access to products that would be better for them.
Patients should ask about their spinal fusion implant
Patients have the biggest stake in their own care. When you are in a lot of pain, and the proposed surgery is an extensive operation that cannot be reversed, such as a spine fusion, the stakes become even higher.
It is in your best interest to avoid an assumption that the hospital, medical device company, device distributor, and the surgeon all have aligned incentives to use the device with the best healing potential. Even not-for-profit hospitals have an incentive to make money.
What few patients know, however, is that it is well with your rights to ask about the financial arrangements regarding the medical device proposed for your surgery, and to ask whether or not there are alternatives that should be considered.
Examples of questions you can ask
For example, questions you can ask your surgeon about your spine fusion include:
- What spinal implant will be used with the fusion?
- Do you have any financial interest in this spinal implant used in the fusion?
- Does the hospital allow you to select your own device for the spinal implant, or does the hospital decide what device you must use?
- Is the spinal implant your first choice? Is this the fusion you would choose for yourself or someone in your family?
It should be a red flag if any other interests, especially financial interests, play a part in the choice of spinal implant for your fusion. It should also be a red flag if your surgeon cannot give a good answer to the above questions, or if the answer is that the device is used because that is the only type available at the hospital.
Simply put, the choice of spinal implant should be determined based on the patient's own needs and the surgeon's judgment of what will give the patient the best chance of having a good outcome.