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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Effects of Standardized Pricing for Distal Radius Fractures
Andrew Miller, MD; Michael Rivlin, MD; Andrew G. Park, MD; Pedro Beredjiklian, MD
Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

Introduction and Hypothesis:

Critical evaluation of implant costs may help to mitigate the cost of orthopedic care. In an effort to decrease the cost burden of operative fixation of fractures of the distal radius, a preset shelf price was established by a large orthopedic practice for all distal radius implants, regardless of manufacturer. We hypothesized that overall expenses would be lower without affecting surgeon behavior or representative attendance in the operating room.

Materials and Methods:
This was a retrospective evaluation on the impact associated costs of pricing for distal radius fracture implants after standardized pricing was implemented. The total number of screws, as well as the number discarded during each procedure were reviewed. We analyzed the financial attributes 3 months before and 3 months after the standardized shelf pricing went into effect. This information was compared for all fellowship trained hand surgeons operating at a single outpatient urban surgical center. Additionally, we surveyed the 10 fellowship-trained hand surgeons in the large private-academic practice affected by the change regarding differences in operating procedure, satisfaction with the pricing change and perceived changes in the attendance and utility of the manufacturer's representative.
We retrospectively reviewed 30 patients that underwent open reduction internal fixation for distal radius fracture 3 month before and 28 patients 3 months after implementation of shelf pricing. There was no statistically significant difference in any of the non-financially related (clinical) variables. Average price difference was $378 (p < 0.0001). Negligible change was noted in the surgeon experience in representative availability. A majority of individuals were satisfied (Likert score > 4.0) with the shelf pricing agreement.

Despite a set price for distal radius implants, we found that there was no significant difference in the number of screws utilized or discarded after the standardized shelf price was established nor any meaningful change in surgeon behavior. Additionally, despite a $378 difference in implant costs, the level of representative attendance and utility was similar before and after the change.

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