Going rep-less without losing OR knowledge: Intralign's new model

Practice Management

Implant costs are one of the biggest expenses associated with orthopedic surgery cases.

However, some companies are now seeking to lower implant prices by using "rep-less" models. Surgeons and administrators are also able to look at implants more critically and consider true cost- and quality-effectiveness when one company's representative isn't a major presence in the room.


"Intralign thinks the rep-less model is the right type of service for the development of orthopedic departments," says Lars Thording, Ph.D., vice president of marketing and public affairs for Intralign. "We talk to hospitals all the time about going rep-less. The bottom line is they want to find a way to better control the surgical episode, and reducing or removing the influence of the sales rep is a major part of this. However, without integrating clinical and operational improvements with such financial initiatives, the solution really won't work."


Cutting out the sales representative entirely also means there isn't a company representative in the operating room during the procedure, which can have an impact on the surgical quality and outcome.


"For many surgeons, the sales rep provides knowledge and value to the operating room," says Dr. Thording. "It would be difficult to produce the right quality of surgery if the sales rep leaves the room in many cases, and that needs to be the focus in discussions about the future of the surgical episode."


Intralign has developed a "rep-less" model that reduces implant costs and ensures continued surgical support and knowledge in the OR; the Surgical First assistance program, which provides the facility and the surgeon with surgical physician assistants and other highly-qualified clinicians to increase efficiency during cases. This person also has a similar knowledge base as the sales rep about products used. Intralign trains their sales reps at an academy to fill the knowledge gap of the sales representatives.


"It's not just all about the sales reps and their influence on surgeons," says Dr. Thording. "They have critical resources that can make sure things are done correctly. We can help provide that service to better control the surgical episode."


According to Dr. Thording, around 80 percent of cases don't need sales reps in the operating room. On a personal level, many reps bond with their surgeons and create a relationship beyond just working on surgical cases as well.


"The sales rep relationship in some places has become more personal and less professional," says Dr. Thording. "They bring coffee as they're showing surgeons a new device. They develop friendships. You want to make sure sales representatives have an appropriate level of influence and insight into the surgical procedure."


Ambulatory surgery centers have been relying on rep-less models, like Flower Orthopedics, or lower cost options because their margins are so low. But hospitals are a different story. While traditionally surgeons have had a little incentive to try out more cost efficient models, things are changing driven by the need to reduce costs and sustain quality, hospitals have begun eagerly looking at the potential in repless solutions. The large implant companies are also very dependent on their sales representatives, and aren't looking to let them go any time soon.


"It's difficult for the large manufacturers to go repless because they are so dependent on their sales reps for business," says Dr. Thording. "But there's no doubt that the current model is not sustainable."


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