Iron Is Hot at Stryker

But he worries that others -- notably patients -- could still suffer under arrangements like HCA's.

"The big three (device makers) haven't come up with anything innovative in the last two to three decades," Chambers insists. "It has always been the smaller companies that they have purchased. But small companies won't be around if they have no access to hospitals."

In the end, some believe, HCA could be hurting itself. They claim that HCA turned its back on discounts offered by non-contract vendors -- particularly Smith & Nephew -- that would have kept their prices down and their orthopedic referrals in place. But instead, they say, the company has taken extraordinary steps to enforce a contract that could bring no clear winners at all.

"I think that HCA has discovered that the contract isn't as good as they thought it was," says one Smith & Nephew representative. "And the contracted vendors aren't happy with the contract, either. They would just as soon see it go away."

>To order reprints of this article, click here: Reprints