New Health Care Passed - Does it include hip resurfacing for the normal patient?

[Pat Walter]

With the passage of the new health care legislation - I can't help but to wonder what will happen to hip resurfacing.

I know this will end up in many disagreements and opinons, but I can't help thinking about it.  Will we all be flying overseas for hip resurfacings in the future?  It is a very expensive surgery and costs more than an old fashioned THR.  Will we just be offered old fashioned THRs now to help cut costs?

I know that no one can answer this question, but as Surface Hippies I would think it is on many people's minds.  With all the changes in Medicare and Medicaid, doctors are just not going to get paid to perform cutting edge technology.  Even before this legislation passed,  most surgeons would not accept Medicare for resurfacing since it is so expensive. 

I can see older people not being offered hip resurfacing since it is so expensive. Maybe not even MOM THRs.  We have come so far with hip resurfacing, I hope this new legislation does not remove it as an option for the common person.  Are we all going to have to fly to India for resurfacing?  I hope not.  I have no way of knowing, just thinking about it.

Now the discussion can begin.  Let's just be kind and not attack each other - just present our thoughts. 

Pat

[DonC]

Hi Pat,

Since hip resurfacing is FDA approved you should see no change. It's important for people to realize that the plan is not a government takeover of health care like in Canada or Britain. The government will not take over hospitals or other privately run health care businesses. Doctors will not become government employees, like in Britain. And the U.S. government intends to help people buy insurance from private insurance companies, not pay all the bills like the single-payer system in Canada.

I see no reason why, as the process improves and becomes more popular, that resurfacing costs come down and be equal to the cost of THR. Dr. Gross did my operation in less than two hours. A total hip would have been longer to do and more expensive as I would have required a custom stem. So for me the resurface was less expensive.

With all the new insured people there will be an expanded need for joint replacement. More customers. This should stimulate innovation. However, as I understand the process, hip resurfacing is not for older people anyway. Doctors will recommend THR for older patients just as they do now.

The bright side is there are limping people in pain that will now be able to buy insurance and get the same care that you and I have been fortunate enough to recieve. I wish them well.

[Pat Walter]

Hi Don

I understand it is not a national health system, but I think we will all be amazed how much influence the government will have in placing guidlines to doctors and insurance companies in what should and should not be done. Especially in efforts to save money and keep insurance rates down.  We are now in untested territory.  Only my opinon. 

About a year ago, I asked many people on the site to express their opinons to medicare about hip resurfacing.  As far as I know, it was not accepted for older people.  I was told insurance companies follow what medicare does.  Since I work closely with doctors, I see a different side of health care than a normal patient.  I was contacted by several medical companies and doctors to try to get opinions posted for the medicare decision.

I just know if you were 65, Dr. Gross would not have done your hip resurfacing since you would be on medicare.  He does not accept medicare for any surgeries.  There are more and more doctors deciding to do that instead of losing money.  So there are many things happening that we as patients don't normally see.

One point I have to disagree with you is - hip resurfacing is not for older people.  I was 61 when I had mine done 4 years ago. If I need my other hip done, I will want a resurfacing if possible.  I know quite a few older people that have had hip resurfacing since they were good candidates.  See how many people were 60+ in must my little survey  http://www.surfacehippy.info/agesurvey.php 

Again, resurfaicng is for the young, the old, the males and females if they are good candidates.  There is no generalization it is not good for old people or women.  It is for you if you are a good candidate. That is a myth that I keep trying to correct.  THere are even posted results that large boned women have the same outcome in resurfacing as men.

Thanks for your thoughts.

Pat

[obxpelican]

Pat,

The bill that was passed only sets up new rules for health care companies and brings in money for those without health care, now bear in mind, this is just the first step in bringing in a single payer or government like health care system. 

If the second step happens all bets are off the table as then you would have a monopoly within a bureaucratic nightmare.

I do not fear the bill that was passed, I do fear the govt being in charge of my health care as nothing the govt runs is efficient or cost effective.  You do not have to go far to see examples, SS is one.


Chuck

[stevel]

Pat,

Hip resurfacing may have cheaper life cycle costs since the device may last a lifetime.
A traditional THR (small femoral head and plastic liner) may wear out and require a revision, so the life cycle costs will be higher.
Since the first modern BHR's were first installed in 1997 (13 years ago), we will need to monitor the performance history.
I suppose insurance companies will need performance data before accepting the cheaper life cycle cost advantage.

[DonC]

My understanding is the older you get the better your chances of femural head fracture due to lowered bone density. This is especially true for women. However, if someone who is active and has good bone density then age does not matter. Test conclude that the ideal patient is 55 or younger.

Another thought to consider is the 2 year prospective study done on the BHR. It said the following... The combined superior regions of the neck showed a statistically significant decrease in bone density at 6 weeks and 3 months. This returned to preoperative levels at 1 year and was maintained at 2 years.   Anyone slightly low in bone density could be at risk for failure and the majority over 65 fit this description. There are a few exceptions.

Rush medical Study: Nov. 3, 2008
"The ideal patients for hip resurfacing are males under the age of 55. They have the fewest, and the least serious, complications," said Dr. Craig Della Valle, lead author and a specialist in joint reconstruction at Rush University Medical Center. "Patients may be eager to take advantage of technological innovations, but for older individuals, a conventional hip replacement is generally more appropriate."  

Dr. Gross transcript on Feb, 2009

TAYLOR_ED] 7:39 pm: What is the average age of your resurfacing males? When is a replacement better than resurfacing?
[Dr. Gross] 7:42 pm: Taylor_Ed: The average age of my patients is 48. My opinion is after approximately 65 years of age. Diagnosis, bone quality and bone defects are also important factors to consider.

[B.I.L.L.]

Pat,

The bill that was passed only sets up new rules for health care companies and brings in money for those without health care, now bear in mind, this is just the first step in bringing in a single payer or government like health care system. 

If the second step happens all bets are off the table as then you would have a monopoly within a bureaucratic nightmare.

I do not fear the bill that was passed, I do fear the govt being in charge of my health care as nothing the govt runs is efficient or cost effective.  You do not have to go far to see examples, SS is one.


Chuck

There is some straight up BS in this plan, I really can't believe people think this is a good idea.  
Salary caps.  Wheres the motivation for someone to become a heart specialist or brain surgeon, (or hip resurfacing guru) when the govt says you can only make X amount know matter how gifted you are or how hard you've worked.  How about that fact that employers will be required to provide health insurance to PART TIME employees, AND THEIR FAMILIES, think thats gonna drive up the price of EVERYTHING ??  It will put me out of business quite honestly. (Or force me to pay guys cash under the table) How about having the gov't decide who gets what treatment and when are you "just too old" to justify a needed procedure ?  They couldn't deal with getting the country a flu vaccine for crissake, now they want to eventually run healthcare altogether ?  God help us.  

[medgerton]

Here is one effect that is factual: Any surgery requiring medical devices will cost more.

The healthcare reform legislation imposes a 2.3 percent excise tax on sales of most medical devices. (ie hip resurfacing devices)

The medical device excise tax would apply to products ranging from surgical instruments to bedpans starting in 2013, according to news reports. The provision is expected to raise $20 billion over 10 years to help pay for healthcare reform.

Reaction from the industry was mixed, at best. Tom Sommer, president of the Massachusetts Medical Device Industry Council, blasted the tax, saying it would stifle growth and put innovation in peril.

"You're certainly going to see an impact on growth and expansion by medical device companies in this country that are going to be faced by a higher tax bill. In addition to job cuts and rollbacks on expansion plans, you're going to see a reduction in R&D spending. Innovation in this industry is definitely in jeopardy, which is shameful," Sommer told MassDevice. "Obviously we're disappointed in the final outcome. The device tax does not take effect until 2013 and we're hopeful that between now and the implementation date we'll be able to scale back, and certainly we'll be supportive of any effort to remove that tax from the law."

[Bionic]

There has been a lot of "noise" and disinformation about this health care bill.  I am very suspicious about the numerous dire consequences that some have warned of.

Remember that the BHR was developed and initially marketed in England, which has actual socialized medicine.  The last I heard, you can still get your hip resurfaced in England and in Canada.

If it's any indication, Smith and Nephew stock has been steadily rising:
http://bigcharts.marketwatch.com/quickchart/quickchart.asp?symb=UK:SN&sid=206109&time=

So has Johnson and Johnson (owner of Depuy):
http://bigcharts.marketwatch.com/quickchart/quickchart.asp?symb=jnj&sid=0&o_symb=jnj&x=0&y=0

Biomet is a private company since 2007, so no stock price data is available.

Of course, the insurance companies can always downgrade service in an effort to improve their profit margins.  So maybe the fact that they can't dump people from their roles any more for being sick will cause them to tighten their wallets and refuse more expensive orthopedic solutions.

But I doubt it.  THe profit motive has always been king at those companies.  If they could have saved a nickel by refusing resurfacing and gotten away with it, they would have done it by now.

[resurface]

Bionic -

Well said. I agree.  There is a danger that too many additional excise fees [taxes] may ultimately stiffle innovation, but we are not even close to that level.  Now, if the US starts to resemble the Japanese market where the nationally set price for implants has eroded some 25+% over the past 3 years then yes.  Try to make a list of industries that have gross profit margins in the range of the medical device or pharma. I will give you one to start your list - Tobacco. 

The sky was falling when Medicare was enacted, the sky was falling when Social Security was enacted, the sky seems to keep falling each time the minimum wage is increased... on and on.  Fatalistic views never materialized.  Our current financial situation has nothing to do with the above. 

In my opinion, Medicare and Social Security are two solid ideas for a society.  There are very few extremely wealthy individuals / families in the US who could afford to opt out [if possible].  The problem is that these programs can no longer be as generous as in the past.  Perhaps there is a party that can bring fiscal responsibility to these programs.

Enjoy the day all... I hope that you are all recovering...

[obxpelican]

I disagree with SS and Medicare being something good for us, we cannot continue down the same path, medicare is set to be insolvent in 2020, yeah, that's 10 years. SS is supposed to last till 2041, then what?  We'll dump more money into it.

Our government has never introduced a social program that is actually efficient and cost effective.  Had we all invested our SS money into CDs we would have been far better than what we're going to end up with.  

Whatever socialized medicine our country ends up with it will be a catastrophe, it will be a bloated bureaucracy just like every other program our politicians have come up with.

Socialized medicine works somewhat well in other countries, it even works for the politicians like Newfoundland Premier Danny Williams, he came here from Canada for his heart surgery, or I could give you the email of my sister in-law who came to America to treat her ovarian cancer.... she was going to have to wait 6 weeks for treatment, she would have died for sure.

My Nephew has autism, they get checks every month, which they blow on everything but for learning aids for him, now their other Son has trouble with math, now they are seeking out a doctor who will label him learning disabled, guess why?  Great use of our SS money.

Someone name me one government program that is efficient and cost effective here in America, our military, maybe but they are not cost effective, remember the $600 toilet seat, how about the $400 hammer?  Maybe NASA, but then they have lots of cost overruns. 

Sorry folks, I desipise all politicians, it does not matter which party either, they are all thieves.

Now off of my soap box.

I feel better now.


Chuck

[Bionic]

SS and Medicare are certainly good things for my retired parents, and for most people who are able to collect benefits.  The fact that these programs are not currently sustainable doesn't make them complete failures--lots of people benefit.  It just means they need to be upgraded to better reflect economic realities.

In my opinion, entitlements are generally a good thing but they need to be coupled with real economic development.  Like a company, the US can't provide benefits unless it's making money, or rather its people are.  A sustainable tech revolution would be mighty welcome right about now.  I'm putting my money on clean energy and bio-tech.

[obxpelican]

Bionic, yes, SS is great for our parents, most people on SS right now are taking more out than they put in, maybe not your parents, but mine for sure, my Dad always laughed about it too.

Our age group will fair much worse, we will receive far far less than what we put into it, the main reason?  Politicians re-defining who can and do receive benefits, like my in-laws for example. 

SS is nothing but a ponsy scheme, all you can hope for is that you get money out before it all folds.

Chuck

[resurface]

Chuck

Hold on a minute.  I know that the Ben Roethlisberger thing has got you all fired-up!  We all agree about the politicians but... why does everyone keep sending their congressman back to Wahsington?  Back to the issue.  

Could you as an individual afford to fund your own health insurance?  Buffett, Gates, and alike.  That's it.

SS, I generally agree, but not for an entire country as diverse as ours.  Many like you and I would like to sign out of the SS program and keep our own money, making our own investment decisions.  I bought Ford at $3.33.  Most US citizens could not do this.  I love my mom but she has no clue about investments, and I don't want her calling me every market swing.  10 yr bonds yielding 3.68%.  

I guess I better get back to work..

GO EAGLES!

[obxpelican]

LOL--- yes, Ben, he's been a disapointment for sure.  

I for one have no problem passing laws that made health insurance a bit more fair, for instance I have no issue with passing laws against pre-existing conditions, not a problem.  Some of what was passed is good.

I do have problems with the fact that the current bill is nothing but a pathway to socialized medicine, the politicians have said it all along that the first bill would be just the beginning of socialized medicine.

I fear a government that cannot even keep solvent the social programs they have currently, let alone something that is going to affect our families health for years to come.

BTW-- close to 4% is still better than the negative number I'll receive from SS.


Chuck

[Pat Walter]

Bionic

But I doubt it.  THe profit motive has always been king at those companies.  If they could have saved a nickel by refusing resurfacing and gotten away with it, they would have done it by now.

I take it you have not been reading on this site and the Yahoo Health Group surfacehippy to read story after story of people trying to appeal their insurance decisions to get a resurfacing. They are still fighting with their insurance companies. I could go thru my emails and send many who ask my advice.

Hip Resurfacing is definitely not an accepted standard for hip replacement or all hospitals or all doctors would be performing it.  Any old orthopedic surgeon will give you a THR - the gold standard.  Don't take it for granted that hip resurfacing is well accepted by insurance companies or the medical community.  It is not.  It is my feeling that it may not be offered as freely in the future as it is now.  That's not saying much since only a very few surgeons in the US even do resurfacing now.  Resurfacing is a more expensive surgery and a more expensive device than a THR, that is why most surgeons will not accept Medicare for resurfacing, they don't want to lose money.

We are on the slippery slope of sliding down into a socialistic country.  People in many other countries don't even have many surgeons doing resurfacing in their countries. These people write to me asking who does resurfacing in their countries like Ireland, Greece, Peru, Africa, Holland, etc, etc.  The purpose of socialized medicine is to provide some care for everyone without busting the monetary system and that's probably a positive statement about socialized medicine.  Everything has to be paid for somehow. When the middle class has dissapeared, where is the money going to come from.

I receive emails from all over the world, with many from Canada and the UK. It is an eye opener about what these people can and can't have - how long they have to wait for what they get.  This is not where we want our country's healthcare system to end up.

Right now not much is going to happen in healthcare, but just give them time.  This is but the first step to "take care of us."  My opinion only.  I sit at home working on the computer all day and listen to Fox News to pass the time.  If only 1/2 or even 1/3 of the information they provide is true - we are all in for a bumpy ride.

A very interesting discussion with many diverse opinions. The only thing for sure is that we all love our hip resurfacings and if or when we need another one - we want that option open to us without having to fly to India.

Pat

[obxpelican]

Pat,

I hope you're not right when it comes to the health care next step.  It's a shame people are still being turned down. 

The problem with you is that you're right so many more times than your wrong.  Of course I'm always right, right?   



Chuck

[Bionic]

Right now not much is going to happen in healthcare, but just give them time.  This is but the first step to "take care of us."  My opinion only.  I sit at home working on the computer all day and listen to Fox News to pass the time.  If only 1/2 or even 1/3 of the information they provide is true - we are all in for a bumpy ride.

Try listening to MSNBC for a while.  It'll make you feel better.

It's important to remember that people had trouble getting insurance to pay for resurfs under the pre-reform system; it's not reform's fault.

Will reform make it better or worse?  At the moment, it looks like reform will benefit the insurance companies by making enrollment mandatory and therefore increasing their numbers of customers.

How that change will filter down to the patients is anybody's guess.  Health insurance companies have been posting record profits.  I'm sure they'll try to expand and extend their profits as much/long as possible, and this will mean paying for less and less while collecting more premiums.  That's just their business model (and also a good reason for offering a public option).

I think Chuck wrote above that resurfacing may be a better surgery in the long run for purely economic reasons.  That's a good argument, and insurance companies would do well to listen to it.  Although resurfs may be more costly than THRs, you usually need just one.  Of course, if resurfs start failing at the same rate as THRs (or if THRs get so good they fail as infrequently as resurfs), then resurfs may be on their way out.  But it seems that would only happen if the market viewed them as roughly equivalent in terms of revision rate.

I see your point, however.  Will the good (reform) be the enemy of the great (resurfacing)?  I think it will depend on a lot of other factors besides reform itself.

[B.I.L.L.]

LOL--- yes, Ben, he's been a disapointment for sure.  

I for one have no problem passing laws that made health insurance a bit more fair, for instance I have no issue with passing laws against pre-existing conditions, not a problem.  Some of what was passed is good.

I do have problems with the fact that the current bill is nothing but a pathway to socialized medicine, the politicians have said it all along that the first bill would be just the beginning of socialized medicine.

I fear a government that cannot even keep solvent the social programs they have currently, let alone something that is going to affect our families health for years to come.

BTW-- close to 4% is still better than the negative number I'll receive from SS.


Chuck

I'm with you Chuck, we have got to do something but turning health care over to the govt is a scary thought. I don't know everything that is in this bill (who does, isn't it 2700 pages or something ?) But I do know that you can't pick up a turd by the clean end...

[stevel]

Most of the latter arguments against health reform are pure crap.  I suppose you'll next say that national health care is socialistic and communist.  I congratulate President Obama and the Democratic party for passing national health care.  Better to spend dollars on our health than pork-barrel defense or paying severance bonuses to the private sector executive frauds at failied wall street firms.  Everybody deserves health care.  Let the rich with incomes over $200 k/yr help fund it through tax increases.  If you go to India or elsewhere overseas, try winning a malpractice suit in a foreign court if your Dr. or hospital screws up!