Controlling Healthcare Costs

People keep asking me what type of health care system I would support.  With some type of health care reform bill soon likely upon us, I suppose it is a timely question.  I hear many others in support of everything from the “do nothing” plan to full fledged socialized medicine.  I don’t know that either one is the answer, but then again, I’m not sure that I have the answer either.

I do know a few things that I see in my own practice.  The first is that physicians across the board over utilize health care resources.  It’s rare to find a physician who has been in practice for any length of time who has not been sued for some supposed act of omission.  When things go wrong, people need someone to blame—and to pay.  So when a patient comes into my office with hip or knee pain and no clear explanation, in spite of the fact that we all have hip or knee pain at some point, more commonly as we age—I order an MRI scan—even though I am 99% confident that it will not show anything of significance.  Sometimes the patient demands it!  There goes $1,000 for another test.  More often than not, the MRI shows some little this or that, but nothing that common sense wouldn’t have told me to treat with activity modification, anti-inflammatories and the usual gamut of conservative measures.

Physicians live in fear of malpractice lawsuits.  Lawyers have made it so easy for patients to file frivolous claims—and threaten not only to trigger an increase in our malpractice premiums, but threaten to exceed our malpractice limits thereby gaining access to personal assets.  With a legal system that makes lawsuits so easy, why not minimize the threat by ordering a test that doesn’t cost us anything—and usually doesn’t cost the patient either? So first, meaningful tort reform is necessary to control healthcare costs.

Second, private insurance companies, I suppose, are the epitome of capitalism in action.  They are businesses whose primary goal is to make a profit for themselves, not care for patients’ health.  But when insurers are allowed to fix prices where they want and make delivery of effective healthcare difficult in order to generate profits for themselves and their stockholders, healthcare suffers.  As much as I believe that capitalism is the key to a thriving economy, something has to be done about insurance companies that put profit before provision of affordable healthcare.

Socialized medicine?  Not so much.  There are so many things wrong with so many government-run bureaucracies that putting more programs into their hands is the last things we want.  Not only will government restrict and ration healthcare to a level not before seen in this country, but the delivery will become even more inefficient and costly.  Look at the per capita healthcare costs vs healthcare services citizens receive in countries that have socialized medicine.  It’s outrageous.  Yes, it all works great—until one gets sick!

So, yes, I do believe that we should have a safety net for all those who cannot get or afford healthcare.  Private insurance companies should not be allowed to profit at the expense of the health of our citizens.  But don’t throw out the baby with the bathwater.  Help physicians take care of patients without the hindrance if insurance companies or government.  And help patients needing care get it.  Control frivolous lawsuits.  And minimize bureaucracy.  Those changes will give us a good start.  And could we do it without that panic that it has to be done “yesterday”—so that we can take time to study the effects of these changes and make rational decisions?  I hope so.

Posted via web from Todd's posterous

Platelet Rich Plasma (PRP)

Todd V. Swanson, MD

Many surgeons are now using biology rather than surgical technology for treatment of a multitude of musculoskeletal problems. Although stem cell therapy holds promise for the future, the use of Platelet Rich Plasma (PRP) is here today.

Platelet Rich Plasma is a concentrate of multiple growth factors normally found in the blood. PRP can now be acquired in the office setting using the patient’s own blood and relatively simple equipment to centrifuge the blood and separate red blood cells from the plasma rich in platelets containing various growth factors.

Some of these factors include such proteins as Transforming Growth Factor-beta, Basic Fibroblast Growth Factor, Platelet Derived Growth Factor, Epidermal Growth Factor, Vascular Endothelial Growth Factor, and Connective Tissue Growth Factor. There are likely many others that we have not yet identified, but these factors, when injected into an area of tissue damage (such as tendinitis, bursitis, or arthritis) stimulate the body to “jump start” the healing process.

Thus far, PRP has been used successfully in the treatment of such ailments as tennis elbow, plantar fasciitis, rotator cuff tendinitis and bursitis, muscle strains, and even arthritis. Additionally, PRP can be used at the time of surgery to accelerate the healing process and sometimes reduce pain.

Although one of the remaining obstacles with use of PRP is getting insurance companies to pay for the procedures, PRP holds promise for the nonoperative treatment of multiple musculoskeletal ailments.

For more information, see this very thorough review:

http://www.prolotherapy.com/PPM_JanFeb2008_Crane_PRP.pdf.

Caveat Emptor

Every month, it seems that healthcare consumers hear about the “latest and greatest” drug, technology, or surgical technique that sounds too good to be true—and too compelling to pass up. Over the past year or 2, the direct anterior total hip approach has received a lot of attention on the Internet and in the media. Is it as good as it sounds?

Well, first, there are many ways to do a total hip replacement. The surgeon can make an incision in the back of the hip (posterior approach), the side of the hip (anterolateral or direct lateral approach), the front of the hip (anterior approach) or using a combination such as in the 2-incision approach. The anterior approach has recently been touted by many surgeons as being superior to other approaches because it “cuts no muscle,” implying that the other approaches must cut a lot of muscles.

So I decided to see if there was any data substantiating the superiority of the anterior approach over other approaches. Woolson, et al recently showed a significantly higher complication rate using the anterior approach (http://tinyurl.com/nt7hnm, http://tinyurl.com/m4fcjh), and Hungerford, et al showed a significant learning curve for the anterior approach (http://tinyurl.com/l6y67g) at this years American Academy of Orthopedic Surgeons meeting in Las Vegas, NV. Seng, et al published very similar results (http://tinyurl.com/ltvr58). Jarrett, et al found no advantages to the anterior approach and noted some distinct disadvantages (http://tinyurl.com/nua37g).

Although the proponents of the anterior approach are quick to point out the theoretical advantages of this approach, the facts do not support their claims, and in fact, some studies suggest that the approach may be inferior to others. So as with all media hype of new technologies, surgical techniques, and drugs, don’t buy into things that sound too good to be true. Many persons and companies profit from use of these products and will make unfounded statements to sell their product directly to consumers and to increase their profits. So when the next new technology is hyped in the media, remember, Caveat Emptor.

Todd Swanson Las Vegas Completes Squeaky Hip Replacement Study

Todd Swanson, Las Vegas, and four colleagues completed a study of squeaky ceramic-on-ceramic hip replacements. Todd Swanson, MD, the primary author of the study, began implanting ceramic-on-ceramic total hip replacements in 1999 utilizing 4 distinct brands of total hip replacements. The study is now complete and the findings were presented at the 2009 American Academy of Orthopedic Surgeons (AAOS) Annual Meeting.

Total hip replacements have come a long way, and Dr. Todd Swanson, Las Vegas, NV, pioneered many of the advances including the mini-incision total hip replacement that utilizes a mere 3-4 inch incision and has patients up and putting weight on the hip immediately. Full recovery takes a fraction of the time compared to older techniques, and many people return to sedentary jobs in 1-2 weeks.

“We were so excited about the mini-incision results, the greatly reduced recovery time and the increased longevity of the ceramic-on-ceramic hip replacements. Then, after implanting around 50 ceramic hips of a particular brand in 2004, we began noticing loud squeaking in some of them,” says Todd Swanson, MD, innovator of the mini-incision total hip replacement surgical procedure and director of the Desert Orthopaedic Research Foundation. “As the number of squeaky hips began to escalate, it became important to isolate the cause and relieve the concern for patients,” Dr. Swanson comments.

From November 1999, to February 2007 Dr. Swanson implanted 306 ceramic-on-ceramic total hip replacements in 267 patients utilizing 4 different brands: 1) Plus Orthopedics, 2) Stryker Orthopedics, 3) Wright Medical and 4) Encore Orthopedics. In the study, 233 patients with 270 total hips were contacted by telephone to complete a survey regarding squeaking of their hip replacement.

Frequency and severity as well as other independent variables were surveyed and rated. Frequency ranged from a squeak less than once per week to daily and severity ranged from perceptible only to the patient to loud--creating a social problem for patient. The study found problem squeaking was associated with only the Stryker Trident acetabular design used with their Accolade hip stem.

Based on the findings of this study, the authors recommend against using the Stryker Trident cup with the Accolade stem. More information on the study can be found at:

http://tinyurl.com/m42kbm

http://tinyurl.com/nu5wrs

Dr. Todd Swanson conducted the study at his Las Vegas research facility with his fellows and medical students: Raghavendran Seethala, MS, David J. Peterson, PharmD, DO, Ryan Bliss, BBA, and Calvin Spellmon, BS.

Todd Swanson, Las Vegas, is the director of the Desert Orthopaedic Research Foundation and is one of the country’s leading Mini-incision Total Joint Replacement surgeons. Since 1997 he has performed over 3000 minimally invasive total hip procedures and has traveled the world teaching this new technique to other surgeons. Research reports demonstrating these procedures and benefits are available at http://tinyurl.com/m2nuv5.
Dr. Swanson is also the Director of the Desert Orthopaedic Center Adult Reconstruction Fellowship Program in Las Vegas.

Phone Number: 702.731.1616
Fax: 702.221.9186
E-Mail: toddswanson.orthopedics@gmail.com

My name is Todd Swanson and I am a Total Joint Replacement surgeon in Las Vegas, Nevada. Since 1997 I have performed over 4000 minimally invasive total hip and knee procedures. I teach these techniques to surgeons around the world and report my own research demonstrating the benefits of these procedures.

I graduated from Augustana College in Sioux Falls, South Dakota and attended Washington University Medical School in St. Louis, Missouri. I completed my general orthopedic training at the University of California, Davis in Sacramento, California and specialized in total joint replacement of the hip and knee during a fellowship at the Metropolitan/Mount Sinai Medical Center in Minneapolis, Minnesota.

Since finishing my fellowship in 1991, I have practiced with Desert Orthopedic Center in Las Vegas, Nevada. I direct the Desert Orthopedic Research Foundation, a not-for-profit research organization working to benefit patients with hip and knee problems. Additionally, I direct the Desert Orthopedic Center Adult Reconstructive Fellowship program, a post-residency training program that prepares orthopedic surgery graduates for a career in total joint replacement surgery. I am also serving as a consultant for orthopedic implant companies and I've developed several patents for joint implants and instrumentation.

Board certified and a Fellow of the American Academy of Orthopedic Surgeons, I focus my practice on total joint replacements and joint preserving procedures for the hip and knee. As head of the Swanson Hip and Knee Center of Excellence and Research Institute, an organization located in Las Vegas, Nevada I've recently launched a program to develop and promote cutting edge techniques and technologies to alleviate hip and knee pain.

Websites: http://www.minitotalhip.com/webpages/index.htm
http://www.minitotalknee.com/webpages/index.htm
http://www.doclv.com/
http://www.americanjointsurgery.com/
http://www.swansonhipandknee.com/

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