.. 

. .

AN OVERVIEW OF


INTRAOCULAR LENS COSTS


,(S VIC 

,0( 't ' 

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.t:tol Yd:m . 

OFFICE OF 
 INSPECTOR GENERAL 

OFFICE OF EVALUATION AND INSPECTIONS 

JUNE 1990 
OFFICE OF INSPECTOR GENERAL 

The mission of the Ofce of Inspector Genera (OIG) is to promote the effciency, 

effectiveness and integrty of progrs in the United States Deparent of Health and Human 

Services (HS). It does thisby developing methods to detect and prevent frud, waste, and 

abuse Create by statute in 1976, the Inspector General keeps both the Secreta and the 

Congress fully and curently informed about progrs or maagement problems and 

recommends corrective action. The OIG performs its mission by conducting' audits 

investigations, and inspections with approximately 1 400 staf strtegically located around the countr. 

OFFICE OF EVALUATION AND INSPECTIONS 

This report is prouced by the Offce of Evaluation and Inspections (OE!), oneof the thee 

major offces withn the OIG. The other two are the Offce of Audit Services andtheOfuce of 

Investigations. Inspections ar conducte in accordace withprofessionals dads 

developed by OEl. These inspetions ar tyicaly short-term studies designed to determne 

progr effectiveness, effciency, and vulnerabilty tofraud or abuse. 

Th report is an overvew of information collected durng th reent OIGstudiesregarding 

introcular lens prices. 

The report was prepar under the dition of Don McLaughlin, Regional Inspector Genera, 

and Jares H. Wolf, Deputy Regional Inspector Genera, Region Vll, Offce of Evaluation and 

Inspections. Parcipating in this project were the following people: 

Kansas City Region Headquarters 

Tim Dold, Team Leader Wayne Powell 

Deborah Walden Project Leader Mark Krushat 

Brian Ritchie 
AN OVERVIEW OF


INTRAOCULAR LENS COSTS


Richard P. Kusserow 

INSPECTOR GENERAL 

OEI. 07.89-o16664 JUNE 1990 
AN OVERVIEW OF 

INTRAOCULA LENS COSTS 

Richard P. Kusserow


INSPECTOR GENERAL


OEI-07-89-01664 June 1990 
EXECUTIVE SUMY


PURPOSE 

This report presents a summary of information collected during


three recent Office of Inspector General (OIG) studies


regarding intraocular lens (IOL) prices.


BACKGROUND 

The Medicare program funds 90 percent of the cataract surgeries 

performed in the united States. During cataract surgery, the 

natural lens in the eye is removed. In over 95 percent of the 

cataract surgeries an intraocular lens is implanted , replacing 

the removed natural lens. In addition to replacing a natural 

lens removed from the eye during cataract surgery, IOLs are 

also used to replace a natural lens missing due to disease or 

congeni tal absence. 

The Medicare program approved payment for 1. 1 million cataract 

surgeries in 1988. Medicare allowed charges for IOLs billed in 

connection with 25 percent of these surgeries averaged about

$324 each. 

Based on OIG recommendations , Federal Regulations published 

February 8, 1990 , established a single payment rate of $200 for 

IOLs provided to Medicare patients in connection with cataract 

surgery performed in an ambulatory surgical center (ASC). 

Prior to March 12, 1990, the effective date of these 

regulations, Medicare reimbursement for cataract surgeries 

performed on an outpatient basis or in an ASC were to be

reimbursed by Medicare based on charges subj ect to reasonable 

cost limitations. 

METHODOLOGY 

The information presented in each of the reports upon which


this overview is based, was gathered using three separate


samples. 

Information regarding the purchase of IOLs through the Federal


Supply Schedule (FSS) was gathered through telephone interviews 

with ophthalmologists and/or procurement specialists in a 

sample of Veterans Administration (VA) and military hospitals 

nationwide. The sample consisted of 10 VA and 10 military

hospitals . 

Information regarding the purchase of IOLs by Indian Health Service (IHS) hospitals was gathered from the only four IHS 

hospi tals where cataract surgery is performed. Interviews were 
conducted with an ophthalmologist in each of the four
 hospitals , and procurement specialists in three. 

Canadian IOL costs are based on information collected from a


sample of Canadian hospitals. In establishing our sample


Provincial Purchasing Directors in each of the ten Canadian


Provinces provided us with names of Canadian hospitals where


cataract surgery was performed. We asked purchasing directors 

in each of those hospitals to provide information regarding


hospital IOL prices and contracts. The rate of currency


exchange on December 31, 1989 , was used to convert Canadian


prices to U. S. dollars. We also interviewed purchasing


directors and ophthalmologists in 13 of the sample Canadian
 hospitals. 

FINDINGS 

The average cost of an IOL is $155 in IHS hospitals and $110 in


Canadian hospitals


The IHS hospitals purchased 47 percent of their IOLs for under


$149 and Canadian hospitals purchased 93 percent of their IOLs


for under $149


IOLs are available on the FSS for $95 to $198


Low IOL prices can be achieved without high volume purchases


The IOL manufacturers are competi ti ve and respond to effective

negotiating techniques 

RECOMMENDATION 

Our findings lead us to conclude that Medicare I s reimbursement 

rate for IOLs is considerably higher than the price established in other markets. We recommend the Health Care Financing 

Administration explore reducing the IOL single payment 

reimbursement rate to no more than $150. At that price Medicare allowed charges would be reduced by $55 million. At 

$125 per lens savings would be $82 million and at $100 per lens savings would be $110 million. 
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

. . . . . .

TABLE OF CONTENTS


Page


EXECUTIVE SUMMRY.......................................


INTRODUCTION 

I?1JJi)?()S; 

1J1\ JCC;R()1JJql). . . . . 

METHODOLOGY. 

FINDINGS. 

The average cost of an IOL is $155 in IRS


hospi ta1s and $110 in Canadian hospitals...........


The IRS hospitals purchased 47 percent of


their IOLs for under $149 and Canadian


hospi ta1s purchased 93 percent of their


IOLs for under $149................................


IOLs are available on the FSS for


$95 to $198........................................


Low IOL prices can be achieved without


high volume purchases..............................


The IOL manufacturers are competi ti ve and 

respond to effective negotiating techniques........


RECOMMNDATION. 
. . . .

APPENDIX A...... 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1 

APPENDIX 

Intraocular Lens Costs in IRS Rospi ta1s 

B............................................. B-1 

APPENDIX 

Intraocular Lens Costs in Canadian Rospi ta1s 

C............................................. C-1 

No Direct Correlation Exists Between 

IOL Volume and Price 
INTRODUCTION


PURPOSE 

This report presents a summary of information collected during


three recent Office of Inspector General (OIG) studies


regarding intraocular lens (IOL) prices.


BACKGROUND 

The Medicare program funds 90 percent of the cataract surgeries 

performed in the united states. During cataract surgery, the 

natural lens in the eye is removed. In over 95 percent of the 

cataract surgeries an intraocular lens is implanted, replacing 

the removed natural lens. In addition to replacing a natural 

lens removed from the eye during cataract surgery, IOLs are 

also used to replace a natural lens missing due to disease or 

congeni tal absence. 

The Medicare program approved payment for 1. 1 million cataract 

surgeries performed in ambulatory surgical centers (ASCs) and 

hospi tal outpatient departments in 1988. Data released by the 

Public Health Service indicates the frequency of cataract
 surgery continues to increase, with some moderation. Medicare 

allowed charges for IOLs billed in connection with 25 percent 

of these surgeries averaged about $324 per lens in 1988. 

Changes have occurred with the reimbursement and place of 

cataract surgery. Medicare reimbursement for cataract surgery 

performed in a hospital inpatient setting is based on

Diagnosis-Related Group (DRG) rates. A DRG rate covers all 

services and supplies connected with a surgery, including 

intraocular lenses for cataract surgery patients. However, 

advances in medical technology have shifted the majority of 

cataract surgeries into hospital outpatient facilities or ASCs. 

until recently, Medicare reimbursement for cataract surgeries 

performed on an outpatient basis or in an ASC were to be 

reimbursed by Medicare based on reasonable cost determinations. 

In these situations , intraocular lenses were to be billed and 

paid for separately. 

Five OIG studies have been conducted regarding the


reimbursement for intraocular lenses. The first study,


entitled "Medicare Cataract Implant Surgery, " (OAI-85-09-046), 

was issued in 1986. This study reported that Medicare 

reimbursement principles neither required nor encouraged


providers to obtain lenses at the lowest available price, and


that the average Medicare reasonable charge payment to an


ophthalmologist or an ASC for an IOL was $365. The inspection 

also found that discounts were available from major

manufacturers , and that in Canada , the same U. S. manufactured 

lenses averaged less than $200. This study estimated that over 

$31 million would have been saved in 1984 , if Medicare lens 

payments had been capped at $200. The study recommended that a 

national cap, based on a generic prudent buyer concept , be 

established for lens payments when lenses are billed separately. 

The second study, entitled "Medicare certified Amulatory Surgical Centers " (OAI-09-88-00490), was issued in 1988. This 

study reported that the problems regarding lens payments 

discussed in the 1986 report had not been resolved. Manufacturers continued to offer discounts , incentives and 

rebates that were not passed on to the Medicare program , and 

that Medicare reimbursement policy did not provide an incentive for providers to be prudent buyers. The OIG again recommended 

that the Health Care Financing Administration (HCFA) establish 

a national Part B reimbursement cap of $200 for any intraocular 

lens billed to Medicare.


More recently, we conducted three additional studies focusing 

on IOL prices , which are summarized in this overview report. 

The first was issued in the form of a Management Advisory 

Report (MA), entitled "Intraocular Lenses Purchased through 

the Federal Supply Schedule (FSS), " (OAI-07-89-01661) in 

November 1989. This study, reported that quality IOLs are 

available on the Federal Supply Schedule. The lenses cost $95 

to $198 , and that the majority of Veterans Administration (VA) 

medical centers and military hospitals purchase IOLs outside 

the FSS for under $200. The OIG recommended that the HCFA use 

the information presented in adjusting IOL reimbursement rates. 

The next study, entitled "Intraocular Lenses Purchased by Indian Health Service (IHS) Hospitals, " (OAI-07-89-01662) was 

issued January 4, 1990, in the form of a MA. This study 

reported that Indian Health Service Hospitals purchased 466 

IOLs for an average of $155, and that IOL manufacturers are 

competitive. The OIG recommended that the HCFA consider the 

prices paid by IHS hospitals for IOLs in adjusting Medicare IOL 

reimbursement rates. 

The most recent report , entitled "Intraocular Lens Costs in 

Canadian Hospitals, " (OAI-07-89-01660) issued April 26, 1990 

reported that Canadian hospitals purchase IOLs for an average 

of $110 each and that low prices can be achieved even for low 

volume purchases. Several effective negotiating techniques 

used by Canadian hospitals in securing IOL contracts were also 

reported. The OIG again recommended that the HCFA consider the 

prices paid by Canadian hospitals in adjusting Medicare IOL 

reimbursement rates , and that the HCFA inform U.S. hospitals of 

the effective contracting practices noted in the report. It was noted that the Medicare program would save $99 million 
annually if Medicare reimbursed for IOLs at the average


Canadian price of $110 , rather than the current Medicare


reimbursement rate of $200. 

Federal Regulations published February 8 , 1990 , became


effective March 12 , 1990, establishing a single payment rate of 

$200 for IOLs provided to Medicare patients in connection with 

cataract surgery performed in an ASC. They also serve as a 

base for IOL payments to hospitals for cataract surgeries 

performed in their outpatient departments. 

We recently received information from the Audit Division for


the National Health Program in London , England , that they


purchase IOLs from a U. S. manufacturer for approximately 30 pounds , ($50) each. The contract covers 15 000 one-piece posterior chamber IOLs to be purchased during a 3-year period. It also covers the purchase of necessary anterior chamber


lenses at the same price.


METHODOLOGY 

A different methodology was used to gather 1989 IOL price


information in each of the three studies summarized in this


report. 

In conducting the "Intraocular Lenses Purchased through the


Federal Supply Schedule" study, we contacted VA and military hospital personnel. A list of the 166 VA medical centers 

nationwide was obtained from the VA. A similar list of the 141 

military hospitals nationwide was also obtained. A random 

sample of 10 hospitals was then selected from each list , for a 

total of 20 hospitals where cataract surgery is performed. We 

conducted telephone interviews with an ophthalmologist and/or a 

procurement specialist in each of the 20 sample facilities. 

In conducting the "Intraocular Lenses Purchased by Indian 

Health Service Hospitals" study, information was gathered from 

the only four IHS hospitals where cataract surgery is 

performed. We conducted telephone interviews with an 

ophthalmologist in each of the four hospitals. Procurement 

specialists in three of the four hospitals were also contacted 

to obtain information the ophthalmologist was unable to

provide. 

In conducting the Intraocular Lens Costs in Canadian Hospitals" study, we contacted provincial purchasing directors 

who provided the names of 19 Canadian hospitals where cataract surgery is performed. We then contacted the hospital 

purchasing director in each of the 19 hospitals to solicit 

information regarding contract prices for IOLs purchased by their hospitals. We requested the number of lenses purchased 

under their contracts, the time period covered by the

contracts , the types of lenses purchased (one-piece posterior 
multi-piece posterior, or anterior chamber) and lens stock numbers. Finally, we requested information regarding any discounts , free equipment , or supplies received in conjunction 

with IOL purchases. 

In addition to collecting IOL prices , we used discussion guides 

to conduct telephone interviews with 12 directors and 8 

ophthalmologists in 13 of the 19 Canadian hospitals. The 

remaining directors or ophthalmologists refused to be 

interviewed or could not be contacted. 

Our calculation of the average cost of an IOL in Canada is 

based on information received from 15 of the 19 hospitals. One 

of the 19 hospitals declined to participate in our study, and

another' s information was never received , resulting in the 

collection of IOL price information from only 17 hospitals. 

Information received from 2 of the 17 hospitals was 

insuff icient and could not be used. 

The currency rate of exchange between Canada and the united 

states on December 31, 1989, (. 8734 U. S. dollars for each 

Canadian dollar) was used in calculating U. s. prices for Canadian IOLs. All Canadian IOL contract price information 

received, for which the contract time period is known , was in 

effect on that date.

FINDINGS


The average cost of an IOL is $155 in IHS hospitals and $110 in


Canadian hospitals


In Fiscal Year 1989 , the IHS hospitals paid an average of $155 

for a total of 466 IOLs purchased from two well-known

manufacturers , neither of which is listed on the FSS. The 

average price of an IOL in each of the IHS hospitals is shown in the chart below. 

Average IOL Prices 

IHS Hospitals


Annual Average Contract 

Hospi tal Volume Dollars Total Dollars 

218 $134. 29, 244. 

106 $166. 17, 626. 

$168. 078. 

$186. 17 484.

Total 466 72, 434. 

Average IHS IOL Price 155. 

The sampled Canadian hospitals negotiated an average price of 

$110 for the purchase of 10, 844 IOLs under annual contracts 

wi th nine U. S. manufacturers, as shown in the following chart. 

Average IOL Prices


Canadian Hospitals


Annual Average Contract 

Hospi tal Volume Dollars Total Dollars 

757 $ 90. , 470. 

1400 $ 72. 101, 850. 

326 $109. 592. 

$148. 424.


1540 $128. 197 736.


990 $ 89. 060.


850 $ 94. 917.


252 $120. 343.


551 $123. 993.


#10/11 1473 $121. 178 733.

Anual Average Contract 

Hospi tal Volume Dollars Total Dollars 

#12 1460 $118. 173, 462. 

#13 264 $245. 64, 796. 

#14 450 $112. 701. 50 

#15 481 $ 93. 079. 

Total 844 $ 1 191 160. 

Average Canadian IOL Price 109. 

Overall average prices paid by the IHS hospitals ranged from 

$134 to $196. Negotiated prices for IOLs ranged from $125 to 

$278 per lens as shown in Appendix A. MUlti-piece posterior 

chamber lenses account for 416 (89 percent) of the lenses 

purchased in these hospitals. Even though one IHS hospital has 

negotiated to purchase one-piece posterior chamber lenses for 

$175 , none were purchased in 1989. 

Under their current contracts , overall average IOL prices in 

the sampled Canadian hospitals ranged from $73 to $245. 

Negotiated prices for IOLs ranged from $68 to $279 per lens, 

wi th only one Canadian hospital paying more than $200 for an 

IOL as shown in Appendix B. These contracts cover a variety of 

lens types , and represent over 10 percent of approximately

100, 000 IOLs implanted annually in Canada. 

It should be noted that the average Canadian IOL price of $110


includes the purchase of one-piece posterior chamber lenses


generally considered to be more expensive. The 

ophthalmologists interviewed indicated approximately 55 percent 

of the IOLs they purchase are one-piece lenses. Forty percent 

of the IOLs purchased are multi-piece posterior chamber lenses, 

and the remaining five percent are anterior chamber lenses. 

Eleven of the twelve Canadian purchasing directors interviewed 

indicated they purchase the contract IOLs on a consignment basis. In such arrangements, the IOL manufacturer(s) provide 

the hospitals with an inventory consisting of a variety of lens 

styles and sizes. This inventory is provided to the hospital 

at no additional charge, and allows the hospital to pay for 

lenses as they are used. 
.._,...., ...........,......_.

The IHS hospitals purchased 47 percent of their IOLs for under


$149 and Canadian hospitals purchased 93 percent of their IOLs


for under $149


The IHS hospitals purchased 47 percent of their IOLs for under $149. The Canadian hospitals purchase 93 percent of their IOLs 

for under $149. Collectively, the IHS and Canadian hospitals 

purchase 91 percent of their IOLs for under $149. 

Percentage of IOLs by Price


Percentage of Total Volume 

120 

100 ._u._-- f3- 98 

80 -­

. m.. ""''''''''_h.........,..._n,


40 ----_u 

Under $110 Under $149 Under $201 Over $201 

Price 

IHS Hospitals Canadian Hospitals 

Medicare reimbursement for most medical items is based on the 

50th percentile for customary charges and the 75th percentile 

as a prevailing charge , rather than a fixed amount (i. , $200 for an IOL). The sampled Canadian hospitals purchase 50 

percent of their IOLs for under $110 , and the IHS hospitals

purchase nearly 50 percent (47 percent) for under $149. Both 

the IHS and sampled Canadian hospitals purchase 98 percent of


their IOLs for less than $200. Only two percent of the IOLs 

purchased by IHS or Canadian hospitals cost in excess of the 

current Medicare reimbursement rate of $200 per lens. 

Appendices A and B display complete lists of IOL costs in the


IHS and Canadian hospitals.

IOLs are available on the FSS for $95 to $198


Four IOL manufacturers have negotiated contracts with the VA to 

offer several different lenses on the FSS, all for under $200. 

The FSS prices for IOLs range from $95 to $198. A one-piece 

lens is available on the FSS for $198. 

The Food and Drug Administration approves all of the lenses on


the FSS. We found nothing which indicated that


ophthalmologists perceived lenses listed on the FSS as being


lower quality. The two ophthalmologists we contacted who use


IOLs listed on the FSS reported satisfaction with the quality


of the lenses.


Low IOL prices can be achieved without high volume purchases


No direct correlation exists between price and the number of 

IOLs purchased by either the IHS or Canadian hospitals. The 

average prices paid by the IHS hospitals ranged from $134 to 

$186 for volumes ranging from 48 to 218. The average prices 

paid by Canadian hospitals ranged form $73 to $245 for volumes 

ranging from 50 to 1540. There was no' significant correlation 

between volume and price in either case, as indicated in the 

charts in Appendix 

The IOL manufacturers are competitive and respond to effective


negotiating techniques


ophthalmologists interviewed in all four of the IHS hospitals 

indicated that IOL manufacturers are competitive and willing to 

lower prices to acquire more business. In two of the four facilities , the ophthalmologists indicated that price was a 

deciding factor in their decision to purchase IOLs outside the 

FSS. 

All 12 of the Canadian purchasing directors interviewed stated 

they had effectively reduced IOL prices over the last couple of

years. They attribute these price reductions to their 

negotiations and bidding processes for IOL contracts. All 

Canadian hospitals purchase their IOLs under negotiated contracts. These contracts vary in terms of bid solicitation, 

selection of lens types , information required from IOL 

companies and contract approval. On the average, four IOL 

manufacturers compete for the IOL contracts in each hospital. 

We found that:


Canadian hospitals solicit bids from several


manufacturers when negotiating IOL contracts.


The number of manufacturers competing for the IOL


contract (s) in each Canadian hospital ranged from

three to seven, and averaged four per hospital. 

Purchasing directors hold the opinion that broader 

bidding holds down costs. 

Canadian hospi tala contracting with more than one 

manufacturer purchase IOLs for less 

The seven Canadian hospitals contracting with more 

than one IOL manufacturer pay an average of $90 per lens. Hospi tals contracting with one manufacturer 

exclusively pay an average of $102. Even though the 

average price difference is only $12, applying a per 

lens savings of $12 to the total volume of 5169 

lenses purchased by hospitals currently contracting 

wi th only one company would result in a $62, 028 

savings to Canadian hospitals. 

Contracts of 24 months or less produce lower average


IOL prices


Canadian IOL contract periods averaged 21 months 

ranging from 12 to 40 months. Canadian hospitals 

purchasing under contracts of 24 months or less paid 

an average of $105 for each IOL. Hospi tals 

purchasing under contracts in excess of 24 months 

paid an average of $122 per IOL, over $17 more per lens. 

RECOMMNDATION 

Our findings lead us to conclude that Medicare I s reimbursement 

rate for IOLs is considerably higher than the price established in other markets. We recommend the Health Care Financing 

Administration explore reducing the IOL single payment 

reimbursement rate to no more than $150. At that price 

Medicare allowed charges would be reduced by $55 million. At 

$125 per lens savings would be $82 million and at $100 per lens 

savings would be $110 million. 
Appendix A


Intraocular Lens Costs


IHS Hospitals


Contract 

Manufacturer Vol ume Price 

Company F 177 $125. 

Company E/G/H $143. 

Company E/G/H $143. 

******************* 47 Percent Under $149 (219) ************** 

Company E/G/H $158. 

Company E/G/H $169. 

Company F $170. 

Company $170. 

Company F $185. 

Company F $186. 

Company F $186. 

Company E/G/H $200. 

98 Percent Under $201 (457) 

Company E/G/H $278. 

A-I 
Appendix B


Intraocular Lens Costs


Canadian Hospitals


Manufacturer 

Company A


Company A


Company A


Company A


Company A


Company A


Company E


Company E


Company E


Company E


Company E


Company E


Company E


Company E


Company D


Company D


Company G


Company C


Company B


Company F


Company F


50th 

Company F


Unknown 

Unknown 

Company E


Company H


Company H


Company H


Company E


Company G


Company G


* **7 5th 

Company G


Company G


Company G


Company G


Company G


Company G


Company G


Company G


Contract U. S. 

Volume Price 200 $68. 200 $69. 1000 $74.
 700 $78.
 412 $87.
 219 $87.

268 $89. 2 $89.
 2 $89.

148 $89.
 25 $89.
 10 $89.
 877 $89. 113 $89.


150 $91.
 60 $91.
 395 $96. 76 $100.
 27 $100.
 240 $104.
 300 $109.
 Percentile***** (5 422) ******************* 26 $109.
 50 $112.
 400 $112.
 127 $113.
 1400 $117.
 52 $120.
 200 $120.
 292 $122.
 60 $122.
 108 $122.
 Percentile***** (8, 133) ******************* 2 $122.
 165 $122.
 2 $122.
 7 $122.
 32 $122.
 7 $122.
 25 $122.


B-1 
Contract 

Manufacturer Volume Price 

Company G


Company G


Company A


Company A


Company F


Company E


Company H


Company C


*****************93 

Company F 

Company E 

Company F 

Company A 

Company E 

Company E 

Company E

****************98 

Company F


Company I 

Company E


Company E


Company E


Company E


Company E


Company E


Company E


Company F


Company E


Total Volume


122 

1300 

132 

Percent Under $149 

150 

312 

Percent Under $200 

10, 844 

$122. 

$122. 

$131. 

$131. 

$132. 

$135. 

$139. 

$148. 

(10 076) ************** $165. 

$165. 

$165. 

$174. 

$196. 

$196. 

$196. 

(10 728) ************** $222 

$240. 

$257. 

$257. 

$257. 

$257. 

$275. 

$275. 

$275. 

$275. 

$278. 

B-2

Appendix C


No Direct Correlation Exists Between


Annual lOL Volume and Price


Canadian Hospitals


Annual Volume Price' 

$300 

1500 

$250 

1250 

$200 

1000 

$150 750 

$100 500 

250 $50 

10/11 12 13 14 

Hospital # 

Contract Volume Average Price 

.Prices shown have been converted to 

S. dollars for comparison purposes 

IHS Hospitals 

Annual Volume Price' 

250 $200 

200 

$150 

150 

$100 

100 

$50 

Hospital # 

Contract Volume Average Price 

C-1