Does Knowing Medical Prices Save Money? CalPERS Experiment Says Yes

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

The fact that the cost of a hip replacement can ring up as $15,000 or $100,000 — depending on the hospital — makes a lot of people uncomfortable. But that’s only if they know about the wide price tag variations. In an effort to raise awareness and rein in what can seem like the Wild West of health care, the California Public Employees’ Retirement System (CalPERS), the second largest benefits program in the country, and Anthem Blue Cross started a “reference pricing” initiative in 2011. The initiative involved a system to guide their enrollees to choose facilities where routine hip and knee replacement procedures cost less than $30,000. Here’s how it works: The CalPERS program designated certain hospitals that met this cost threshold, and enrollees who chose among these facilities pay only the plan’s typical deductible and coinsurance up to the out-of-pocket maximum. Patients who opted for other in-network hospitals were responsible for regular cost sharing and “all allowed amounts exceeding the $30,000 threshold, which are not subject to an out-of-pocket maximum,” noted the report. The results tallied savings of $2.8 million for CalPERS, and $300,000 in patients’ cost sharing, according to research released Thursday by the Center for Studying Health System Change for the non-profit group National Institute for Health Care Reform. Researchers found that patients who received “intensive...

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Hip Replacement Lawsuit: ASR Settlement ($2.5 Billion) Benefits Announced

The settlement terms of the ASR HIp Implant lawsuit have been announced:

The ASR Settlement provides for three basic areas of compensation. 

The first is a Base Payment to all ASR Claimants (XL and resurfacing) who have undergone a revision surgery, removing the 
acetabular cup, prior to August 31, 2013. 

The second is for Claimants who have undergone a revision surgery in both their left and right hips (Bilateral Claimants). 

The third addresses patients who have suffered a variety of medical complications following a revision surgery (Extraordinary Injury Fund).

 In addition, the Settlement provides for the resolution of healthcare insurance liens for 
medical costs that are directly associated with the revision surgery, at no additional cost to the 
claimant. 

Click here to read the complete press release issued by the Settlement Oversight Committee

Click here to read about the lawsuit.

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Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  have been representing injured workers and their families who have suffered occupational accidents and illnesses.

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Johnson & Johnson hip implant settlement price could soar above $4 billion

Today's post was shared by FairWarning and comes from www.nj.com

A settlement Johnson & Johnson finalized yesterday over faulty hip implants could be worth more than the initial $2.5 billion price.  Johnson & Johnson agreed to pay at least $2.47 billion to settle thousands of lawsuits over its recalled hip implants, lawyers for the company and patients told a judge in outlining an accord that may be worth more than $4 billion. The agreement would resolve about 8,000 U.S. suits against J&J’s DePuy unit brought by patients who have already had artificial hips removed, Susan Sharko, one of the company’s lawyers, told U.S. District Judge David Katz yesterday in Toledo, Ohio. The company will pay an average of about $250,000 for each surgery and cover related medical costs, Sharko said. “The settlement provides compensation for eligible patients without the delay and uncertainty of protracted litigation,” Andrew Ekdahl, worldwide president of DePuy Synthes Joint Reconstruction said in a statement. The settlement, which doesn’t require the judge’s approval, is the second multibillion-dollar accord this month for J&J, the world’s largest seller of health-care products. The company, based in New Brunswick, New Jersey, agreed Nov. 4 to pay $2.2 billion to resolve criminal and civil probes into the marketing of...

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Report: Johnson & Johnson could settle hip replacement lawsuits for $4 billion

Today's post was shared by Legal Newsline and comes from legalnewsline.com

Johnson & Johnson has agreed to settle thousands of lawsuits over defective all-metal replacement hips for up to $4 billion, according to reports this week. Sources told The New York Times Tuesday that the tentative plan would include patients who’ve already had the devices — Articular Surface Replacements — removed and replaced with something different. Under the deal, each patient would receive about $350,000 on average in compensation. The $4 billion settlement would be one of the largest payouts for medical device product liability claims, the Times noted. But the final cost could increase, depending on how many claimants already implanted with the devices end up having operations to replace them in the future, the sources told the newspaper. DePuy Orthopaedics, a subsidiary of Johnson & Johnson, recalled the ASRs in 2010. Since then, more than 10,000 people have sued in state and federal courts in the United States. The metal-on-metal replacement began to fail soon after implantation, as opposed to plastic and metal hip implants. Those typically last 15 years or more. With the DePuy replacement, metal can flake off into the body and cause tissue and bone damage. From Legal Newsline: Reach Jessica Karmasek by email at jessica@legalnewsline.com.

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Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  have been representing injured workers and their families who have suffered occupational accidents and illnesses.Related articles

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Knee Replacement Medical Device Recalled

The US Food and Drug Administration  (FDA) has notified healthcare professionals of a Class I recall of the LPS Diaphyseal Sleeve, a manufactured medical device used in human knee replacement surgery.

It has been found that The LPS Diaphyseal Sleeve to Diaphyseal Sleeve Base taper connection may not be sufficient to accommodate potential physiologic loads that may be transferred to the junction during normal gait activities by some patients. This may result in fracture of the sleeve at the taper joint which may also lead to loss of function or loss of limb, infection, compromised soft tissue or death.

The device was manufactured by: DePuy Orthopaedic, Inc, a company owned by Johnson and Johnson.

FDA Orders Surveillance of Hip Implants

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Hip replacements are utilized through the workers' compensation medical delivery system in an effort to cure and relieve medical conditions arising out of employment injuries and exposures. The US Food and Drug Administration (FDA) has recently announced that it is widening its roll in monitoring the hip implants. This follows a recent recall of defective hip implants.

"The FDA is continuing to gather and review all available information about currently marketed metal-on-metal hip systems, including information related to adverse events that may be associated with increase levels of cobalt and chromium in the bloodstream. To that end, on May 6, 2011 the FDA issued orders for postmarket surveillance studies to manufacturers of metal-on-metal hip systems. The FDA sent 145 orders to 21 manufacturers. Manufacturers will be required to submit a research protocol to the FDA that addresses specific safety issues related to these devices. Data from the studies conducted will enable the agency to better understand these devices and their safety profiles.

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Defective Artificial Hips Maybe a Costly problem for Workers' Compensation

The workers' compensation insurance system is about to be the initial payor for joint replacement surgery and for the complications of defective artificial hip joint damage that were said to be inadequately tested because of a loophole in FDA's rules. With an estimated 93,000 DePuy recalled artificial hips implanted worldwide, the workers' compensation benefit system will probably be paying for a vast amount of the remediation and treatment costs, and then having its hand out through direct and indirect subrogation efforts to seek reimbursement from the manufacturer, Johnson and Johnson.

Called "one of the most troubled orthopedic implants of the past decade," recently recalled Johnson & Johnson artificial hips, DePuy Orthopedics, have drawn recent attention for being sold and promoted without adequate testing. The concern has been focused on devices known as A.S.R., Artificial Surface Replacement hip joints. The device was first introduced in the US in 2005 and was recalled from the market in August 2008.

The New York Times reported that, "Current rules do not require device producers to notify the F.D.A. when they bundle together components from approved and unapproved devices, Mark Melkerson, an agency official, acknowledged. New iterations of device designs already used on patients typically receive scant scrutiny from the F.D.A. before going to market."

It further reported that, "... back in 2005, the F.D.A. allowed DePuy to start selling the other version of the A.S.R., a modified standard hip replacement that used the same A.S.R. cup found in the company’s unapproved resurfacing device." 

As a result of hip joint pain following surgery, and many adverse reports, and surgical implant failures, further investigation have resulted in the recall of DePuy Orthopedics, ASR artificial hips,  Some individuals may suffer damage to bones, muscles and nerves following implant. Lawsuits have been filed against DePuy.

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Hip Implants Recalled Due to Failure

Johnson and Johnson has recalled 2 Hip Implants because of failure. The two implants were made by the DePuy Orthopaedics unit of Johnson and Johnson. The decision to withdrawn the products was based upon the fact that many patients require a second hip replacement because of product failure.

DePuy release a statement today that they two products being recalled were: the ASR XL Acetabular System, a hip socket used in traditional hip replacement, and the ASR Hip Resurfacing System, a partial hip replacement that involves placing a metal cap on the ball of the femur, a method intended to preserve more bone. There about 93,000 of the defective appliances that have been implanted worldwide.

For over two years the US Food and Drug Administration (FDA) has been besieged with complaints about the failure of the devices and painful surgery to replace them.

The office of Jon L. Gelman has advocated for consumer rights and has helped those who have unfortunately received defective medical devices. Please call 1-973-696-7900 or e-mail for further information.

Workers' Compensation and Joint Replacement

• Preventing Joint Replacement Surgery in Workers' Compensation Claims 

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