Medical device makers, facing sluggish sales and increasing pressure to prove the value of their products, are beefing up guarantees to compensate US hospitals if a device does not perform as expected.

Medtronic Plc, Johnson & Johnson and St Jude Medical Inc are among the first to provide the newer guarantees, some of which offer to share in the cost of follow-up treatment tied to their heart devices, company executives told Reuters. Orthopedic implant makers are exploring such agreements for hip and knee devices.

Hospital officials, however, are seeking even more robust performance guarantees, including pledges to cover the cost of the surgery when a device needs to be replaced. Some see the new offers as a starting point for manufacturers to begin to share more of the financial risk of procedures.