Sounding board - Truth or consequences

Several years ago, I served as a panelist at a conference on health care ethics at a university-affiliated community hospital. The chief of orthopedic surgery asked my opinion of a proposal made to him by the hospital's chief executive officer (CEO). The CEO explained that the hospital was losing money on hip-replacement surgery, because the payment the hospital received from Medicare, which paid for nearly all hip replacements, was less than the hospital's cost. A major component of the cost was the price of the hip prosthesis. The CEO requested that the orthopedic surgeons use a much less expensive prosthesis in patients older than 80 years whom they judged to be unlikely to live 10 years or more. He understood (and the chief of orthopedic surgery concurred) that the less expensive prosthesis was as good as the one then in use, except that it was less durable and more likely to fail 10 years or more after implantation. The CEO argued that it was unlikely that very old patients would benefit from the greater durability of the more expensive prosthesis. If the chief of orthopedic surgery did not agree, the CEO would limit the number of patients who could undergo hip-replacement surgery at the hospital. The chief of orthopedic surgery and his colleagues were community practitioners wholly dependent on clinical fees for their professional incomes.