Letters
Musculoskeletal diseases
Volume 197 - Issue 3

No more excuses: fracture liaison services work and are cost-effective

Author:  Nikolai Bogduk

Med J Aust 2012; 197 (3): 147. || doi: 10.5694/mja12.10690
Published online: 6 August 2012
To the Editor: In their letter, Spencer, Howe and Manolios call for investment in fracture liaison services.1 Our own business plan showed that for an investment of $55 000 to hire a nurse, the dividend is $1.5 million in second surgeries prevented. This plan has failed to impress successive chief executive officers or their finance managers, and for good reason. The obstacle is a financial paradox. If a chief ...
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To the Editor: In their letter, Spencer, Howe and Manolios call for investment in fracture liaison services.1 Our own business plan showed that for an investment of $55 000 to hire a nurse, the dividend is $1.5 million in second surgeries prevented. This plan has failed to impress successive chief executive officers or their finance managers, and for good reason. The obstacle is a financial paradox.

If a chief executive was to provide $55 000, they would not see $1.5 million in cash return, but would be left with a $55 000 deficit, for which they would be castigated. The reason for no visible return is that the vacancies created by the saving in second surgeries would immediately be filled by other orthopaedic patients. Orthopaedic surgeons would not take time off, at no pay, for the period that they would otherwise have spent operating on the patients requiring second surgeries. So, to an accountant, the business plan is suicidal. It amounts to giving doctors yet more funds for no tangible savings, and incurring yet more deficit.

There is a resolution to this paradox. On investing in a fracture liaison service, a hospital should not expect to see cash savings. That investment, however, creates something else. The $1.5 million saving in second fracture surgeries will be spent on other orthopaedic cases. So, the dividend is $1.5 million of enhanced performance in other domains of orthopaedics. Cash does not flow, but performance figures improve. Therefore, the business case should be cast as “$55 000 buys you $1.5 million of extra key performance indicators”.

I thank Spencer, Howe and Manolios for precipitating this epiphany. I will try the new proposal on our administration.

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