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The Journal of Bone and Joint Surgery 80:606-7 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

Joseph Bernstein, M.D., Hans J. Kreder, M.D., Richard A. Deyo, M.D., Thomas Koepsell, M.D., Marc F. Swiontkowski, M.D. and William Kreuter, M.P.A.

TO THE EDITOR:

Given the Health Care Financing Administration's proposal to designate so-called centers of excellence as part of its total joint demonstration project, the article "Relationship between the Volume of Total Hip Replacements Performed by Providers and the Rates of Postoperative Complications in the State of Washington" (79-A: 485–494, April 1997), by Kreder et al., is a very interesting and timely piece of scholarship.

I register these comments about the paper.

First, in my experience as a medical student at Cornell and as a resident and attending physician at the University of Pennsylvania, I have seen that surgeons with a high-volume practice tend to attract patients from a very wide geographic area. Accordingly, a patient who is managed by such a surgeon in New York, for example, may be treated for a medical complication at a hospital in New Jersey (or New Mexico or even New Delhi). Thus, scanning . . . [Full Text of this Article]


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