Health Policy, Ethical, Business, and Financial Issues Related to Blood Management in Orthopedics

For patients with hemorrhage or severe anemia, blood transfusion can be life-saving, and without a safe and available blood supply, many orthopedic procedures would not be possible. In fact, blood transfusion is the most commonly performed medical procedure in the United States hospitals. However, transfusion is also one of the top 5 overused procedures, according to the Joint Commission. This determination is based primarily on multiple recent studies showing that "less is more" in terms of transfusion, and that lower hemoglobin thresholds of 7 to 8 g/dL are ideal in patients who are not actively bleeding. With increasing efforts to optimize blood utilization, the field of patient blood management (PBM) has grown rapidly over the past decade. According to some, PBM means giving the right dose of the right product to the right patient for the right reason. One of the most enticing concepts behind blood management in orthopedic surgery is that we can reduce risk, improve outcomes, and save money, all at the same time. Given that blood is reimbursed either poorly or not at all in the United States, owing to the bundled payment system, and that the overhead costs of transfusion that are ∼4-fold the acquisition cost, a solid PBM program will easily support itself by reducing unnecessary transfusions and their associated costs. The purpose of this article was to review the health care policy, ethical considerations, and financial implications of PBM and to illustrate how blood management adds value to the care we deliver.