Thursday, February 13, 2014

Saving Private Heary

The recent brouhaha that has created an imbroglio between Mr. Richard Kaul (aka Dr.) and Dr. Robert Heary (Neurosurgeon) has been high drama at its best.  For those of you that haven't been following this saga, Mr. Kaul has been fighting the forces of evil, involving a total conspiracy between the State of NJ Medical Licensing Board, the orthopedic and neurosurgical community, the press, his former patients, and "Fat Boy Slim, aka Chris Christie.  (Let's kick some more dirt on the round mound of rebound.) The irony of it all is that Poor Richard sees himself as a pioneer, a visionary, as being misunderstood. Who knows, maybe a descendant or protege of Michael DeBakey? In November of 2013, Mr. Kaul blogged on his own blogsite, while sitting in the lotus position, asking the question, "Who is the Spine Blogger?" One must admit, even TSB doesn't have the panache that Mr. Kaul exhibits when blogging.  Richard, you don't mind if I call you Richard?  Delusion? Deceit? I must suspect that you never heard the express that "people with a glass jaw shouldn't start a fight."

As for Private Heary?  I do declare, even TSB must come to his defense.  I feel like Captain John Miller in his quest to bring Private James Ryan home back to comfort and loving arms of his mother.  TSB normally wouldn't give Mr. Kaul the time of day, let alone some publicity on the blog, but when someone accuses The Spine Blogger of highly inflammatory comments, let alone, making or allowing racially disparaging remarks about Indian physicians, that's where TSB draws the line. Richard just for your information, I love Indian Food and hang out with Indians, not the type that run around with bow and arrows. Professional toxicity, c'est moi.  Rather than get into a pissing match with someone insignificant I would rather let Richard's track record speak for itself.  I watched your "self-serving" YouTube Videos, intellectual discourse at its best coming from someone who is a self-proclaimed spine surgeon.  So in a gesture to ensure you that the symbolic head has not been cut off…………..drumroll please………..Robert Heary is not the Spine Blogger. So in closing

"Richard do you understand me now, 
sometimes I feel a little mad, 
but don't you know that no one alive can always be an angel, 
when things go wrong, I seem to be bad 
But I'm just a soul whose intentions are good
Oh Lord, please don't let me be misunderstood!"

A man of your intellectual capacity should know that sometimes its better to let a sleeping dog lie

Wednesday, September 4, 2013

He's Back!!!!!!!!!!!!!!!!

Spine Nation:

TSB is back!!!!!!!!!!!!!  Come here, just a little bit closer to the camera on your MacBook Air.............just a little bit closer...........come on, I can see you...........I know, I missed the missed the analysis.......but most of all you missed TSB.  Don't believe it?  I'll send you a copies of the emails.  So where has TSB been? 

After a much needed break from the show, it almost feels like the first day of school!!!! (Just Kidding)  It's almost surge like. TSB has just completed his first movie on Spine in the Middle East.  The story revolves around an American executive (ahem) who goes to work for a Middle Eastern despot and is tortured by his lies and deceitfulness, only to find out that freedom is just another word for nothing left to lose, nothing don't mean nothing honey, if it ain't free, and feeling good was easy, Lord, when he sang the blues.  Yes, fellow bloggers, TSB has been away so what's new in Spine?

  • Nothing?
  • POD's still Exist?
  • Is Closet spine still in business?
  • The DOJ investigating the Distributor's Role as intermediary in buying surgeons business?
  • Neurosurgeons being sued for misuse of product? No way!
  • Blackstone resurfaced?
  • Shareholders suing Nuvasive?
  • Is the Choice still yours? 
  • Are the V Brothers still in spine?
  • Carragee must resign?  That was funny.
  • OTW winning the MORE is less award for journalistic excellence?
  • Is Orthoworld still in business? 

Over the next few weeks TSB will be launching a new website, which will cover much more than spine with a new cast of characters.  So stay tuned, stay in touch, and let us know what you know. The fun is about to begin.  Many thanks go out to those loyal readers and followers, and thanks for the  paid vacation, it was well worth it.


Thursday, April 11, 2013

'Cause the Heat Is On!

On April 9th, 2013 it was reported by TSB's favorite Spine Journalist, John Carreyou that Federal Agents are looking into fraud allegations at companies owned by Michael D. Drobot.  The obvious facility that comes to mind is Pacific Hospital of Long Beach, a 184 bed facility that has had a reputation well known within the SoCal spine community. Though the affidavit to search and seize were sealed, most of you that have sold in this area can embellish on your own experiences with Pacific. In addition to Pacific, Federal Agents also served search warrants on a company named Industrial Pharmacy Management, LLC, a Newport based company that dispenses medications to patients in doctors offices.  TSB must admit, when it comes to creative business models, we are sure that the Golden Gate State outshine the Volunteer State, Texas, Alabama, Florida or that bastion of culture and panache, Mississippi.

Entertaining?  Well, as TSB likes to say, "the show is just beginning."  A spokesperson at the hospital immediately responded to these "misunderstandings," and the parties involved intend on working with authorities to resolve these issues.  The reaction in the WSJ by a few of its readers is indicative of the negative climate that the public exhibits when it comes to government intervention regarding allegations of healthcare fraud.  The general public should be outraged. With the exception of those surgeons or businessmen wives whom will rail about how hard their husbands work to support a lavish lifestyle at the cost of the American Healthcare System and the public, we should demand that business models that increase the cost of delivering healthcare in an already out-of-control healthcare environment, that are bilking Medicare out of billions of dollars be prosecuted to the fullest extent of the law.  

TSB is willing to debate what constitutes a "self-inducement"with anyone involved in a POD, POC, Physician Owned Hospital.  But who wants to have a debate?  With the U.S. Postal Service and Department of Defense, and California Labor and Insurance Departments involved, you know what TSB says, "where there's smoke there's fire."

"The heat is on, on the street
Inside your head, on every beat
And the beat's so loud, deep inside
The pressure's high, to stay alive
Cause the heat is on."

Thursday, March 28, 2013

Here Comes The Rain Again!

Here comes the rain again, falling on my head like a memory, falling on my head like a new emotion
I want to walk in the open wind, I want to talk like lovers do, I want to dive into your ocean, Is it raining with you?

Yes fellow bloggers, here comes the rain again, it's the time of the season when love runs high at the OIG. That acronym stands for the Office of Inspector General. On March 26th, 2013 the OIG issued a special fraud alert for physician owned entities. Wah! Wah! Could the Federalis have finally come to their senses? I mean they have gone after Julian Assange, Pvt. Bradley Manning, internet wiz kid Aaron Swartz, while giving Wall Street a pass, claiming that they are TBTF but also too big too prosecute. Oh, who said crime doesn't pay?  Where's Vanilla Ice when you need him? As POD's and POC's continue to proliferate the medical device sector, while dividing companies against physicians, physicians against salespeople, the OIG's concerns focus on the strong potential for improper inducements between and among physician investors, the entities that they are involved with, device vendors, and device purchasers.

Essentially, the penultimate question remains; "do POD's and POC's violate anti-kickback statutes?" For years, this issue has been debated. Does this type of business model affect a surgeons decision making process? The last five years in spine has tarnished an industry that was once respectable. From the Wall Street Journal to the NY Times, from Long Beach, California (can I hear casino backed medicine?), to Tennessee, Mississippi, and Alabama (the birthplace of POD's?), to Florida, to The Spine Blogger, POD's and POC's have been subject to scrutiny. As TSB claims ever since private equity and orthopedic investment banks took hold of the opportunities to capitalize and profit in a healthcare market that had very little oversight provided by the government, everybody has partied like its 1999.  The foxes have been guarding the hen house. Yet, slow but surely all things must pass. As Glenn Frey once sang, "the heat is on!"

Systemic abuse in healthcare is rampant. From the hospital CEO's and facilities hiding behind "non-profit" tax exemptions, to the physician consultants, to the insurance industry, to device companies, to the hospital staff, to RapeTrax and VendorRape (that's the next scam that needs to be investigated), to salespeople, to investors, everyone needs to take responsibility for their actions and how those actions have contributed to the rise and fall of the American healthcare system. From patients who cannot control their vices, to greedy investors who cry about FDA oversight because time and money drive their thoughts, to greedy surgeons who probably hate their medical careers only to moonlight as fictitious entrepreneurs, to those whom complain about entitlements only to use their Medicare at every chance they get, everyone gets some blame. Anyone who denies that their personal and professional judgement is not tainted by having a vested financial interest in a POD or POC is higher that Hunter Thompson leaving Las Vegas.  

If a group of slimy surgeons start a POC and are the only customers using the product, or, are enticing other physicians to use their product by providing them with an inducement, isn't that illegal? The definition of inducement is something that motivates, stimulates, or creates an incentive, and what better way to incentivize a surgeon? The only way you make more money as a surgeon is by performing more surgeries. Let's take some examples. Say a start-up company that has plenty of cash decides to hand out equity in return for sales volume, is that an inducement? Wouldn't having a vested interest in the success or failure of a medical device company be construed as a inducement? Especially, if the surgeon had the ability to drive up the valuation of the company by implanting more product?  Let's try another example, let's say a company created a platform whereby they subsidized a Fellows or residents start-up practice in exchange for their loyalty meaning only using their product, could that be construed as an inducement?  Say ten surgeons invest one hundred thousand dollars each in a company and only use that specific company's products, regardless whether those products have the same quality or meet the safety standards of a competing product, is that good medical judgement? Let's say the implants break, or the rod reducer malfunctions every time the surgeon uses it, resulting in a fracture of the patient's pedicle, and the surgeon investors fail to report it to the FDA because they have a vested interest in the company, is that good medical judgement? Let say you have a pedicle screw head that splays in-vivo, you change the design without notifying the FDA, and the surgeons that are getting paid to use the product never report it to the FDA, is that legal?  Let alone do they have the incentive not to report it? These are the types of scenarios that patients and the government are not privy to until some individual risks his or her career and files a whistleblower complaint or a patient gets hurt or killed. There is no oversight.

Isn't it interesting that the states where activity has been rampant include, California (there's gold in 'em hills), Utah, Alabama, Texas, Mississippi, Florida, and Tennessee, just to name a few.  I mean, even Nuvasive has complained about POD's affecting their business. If you prey on the elderly (Medicare patients), the uneducated, the misinformed, the helpless, PODs and POCs have torn down a once respected profession and industry. As my granddaddy use to say; "if you hate your career, do something different." There will be complaints about big brother imposing more rules and restrictions. About tort reform, about Obamacare. That will be construed as nothing more than an irrational projection on who is to fault for the state of the U.S. healthcare system. There will be complaints and arguments made about how much it cost to get a medical education in the United States. Here's a clue, don't go to medical school. Yet, this isn't really about free markets, it's about patient safety, it's about the publics safety, it's about abusing the Medicare system whether our readers believe it or not. There have been more than one Dr. Makker's in the industry. Unfortunately, he was not only greedy but a terrible surgeon.  Where was the oversight?  When your own peers are not willing to condemn you and exile you until there is public outcry, what type of society have we become?  Just read some of our readers experiences while working in spine. We have become a society that the end (making a lot of money) justifies the means. Money obfuscates reality.

Corruption of medical judgement? Overuse to increase the cost of Federal healthcare programs? Unfair competition? Not in spine. No siree! When you control whose product you will use, how many times you use it, and where you will operate because you have a financial interest in an entity, is that a free market? After twenty-five years in the device industry, something is amiss. Those who are involved in POD's or POC's will wrap themselves in an outcry of "free markets." They will say that we are becoming a socialist society, but even free markets must have rules. That is why you can't drive at 120 miles an hour in a 55 speed zone, or yell "fire" in a crowded movie theater. Without rules we become a lawless society with no boundaries.  Just look at where we are today?  As Yogi Berra use to say, "when you come to the fork in the road, take it." TSB wants to know what our readers think?

Wednesday, March 6, 2013

Talk About Circling the Bowl - Spine Frontier

Word on the Street is that Spine Frontier, a company where no man has ever gone, traveling through multiple galaxies, light years ahead of its time beyond Mars, (isn't there some millionaire that wants to fund a trip to Mars) is lying in the spine industry's intensive care unit looking for another sucker, oops, TSB means another investor that can set up a  life line and infuse some capital into a hemorrhaging and dehydrated patient. Oh Kingsley (is it Ben), as George Harrison stated, sooner or later "all good things must pass." There's birth and then there's death. How many people have taken precious time to listen to the Spine Frontier story? It's a solution to a problem that really doesn't exist at least on a major scale.  This has been more theater than anything else. Like Trans 1 and Baxano, maybe SF can cut a deal with VTI, they know how to burn through cash. Who knows, maybe it would resurrect Touchdown Tommy's career? Is he still stuck in the Heisman pose? It would be entertaining witnessing the blind leading the blind. Anyway, TSB has alerted the coroner, the body bag is ready, unfortunately, we have been informed that before they pick up the body they would like prepayment.  Hi, Ho, Hi, Ho, it's off to play we go

Monday, March 4, 2013

Trans 1 Buys Baxano

Today's news flash pertains to the acquisition of Baxano by Trans 1.  As TSB would ask, where's the synergy, or is there any synergy?  You be the judge.  Could this be a strategic move to bolster their product portfolio.  How much has this deal diluted the stock? Is this a deal made in heaven or made out of desperation.  And who wins?  At least on the surface the people that started Baxano, at least on paper.  TSB wants to know what our readers think?

Tuesday, February 19, 2013

This Week's Editorial

Recently one of our readers commented, "what this industry needs is an independent, professional, moderated blog!" Are you serious?  First of all Einstein let TSB explain some facts before anyone reads the proceeding post.  This blog has been as independent of anyone's influence as any public forum has ever been.  We have never taken one dollar from the industry. As for professional?  Well, TSB and those that have contributed to our forum continue to represent themselves with some modicum of decorum unlike many of you that work in the industry believing in words like "ethics and integrity." You are  correct in stating that a blog needs to be moderated, but then, wouldn't you be one of first to declare that your first amendment rights have been violated if TSB decided to delete your comment because I did't like what you said about me or for that matter someone else. As usual there are rules......try not to be too vulgar, don't bring anyone's spouse or children into the picture and everyone is fair game.  Don't be so thin skinned, I've been called more names than anyone else and have never censored someone's opinion. TSB is not the N.Y. Times, the WSJ, or the Washington Post, or for that matter Orthopedics This Week (if ever there was a shill for the industry and proud of it). If TSB wrote about how wonderful everything was, you and your cohorts would declare that TSB sold his soul to the industry. That's what today's journalist lack, the truth. Making those types of comments brings you some temporary relief, its like ibuprofen, yet your comments are as funny as reading that Tom Horton, CEO of American Airlines did a tremendous job leading the company out of bankruptcy, only to be rewarded with a severance package of nearly $20 million.  But on to our next post.............................

We know that the U.S. Healthcare Industry has become Barnum and Bailey's greatest show on earth. Clowns to left of me, jokers to the right. The words that are synonymous with spine include; chiseler, gouger, scammer, swindler, con artist, cheater, rip-off artist, con man, con woman, charlatan and off-course "puttana," which is the most appropo word that clearly defines this industry.  Many of you experience or even exhibit this type of behavior on a daily basis. Whether you are dealing with hospital administrators, surgeons, company management teams, O.R. supervisors, the companies you work for, the patients, the thieves (who's getting those kickbacks) that created RapeTrax, VendorRape, the POD's, POC's, Orthoworld, OTW, and last but not least Physician Owned Hospitals. The bottom line is that there is no honor amongst thieves, at least not in this lifetime. Greed rules and selfishness takes precedence over any sanity. But then again, when you have never thought for yourselves, many of you deserve to be herded like cattle or sheep. Wonder why the government finally got involved in slapping around healthcare? How many senseless procedures?  How many more diagnostic tests?  We are an industry that continues to sprial out of control, while the CEO's and surgeons blame tort reform. Hell, forget about the industry, just look at the behavior of our elected officials. Who ever said that great dynasty's don't collapse? History has proven that, and will prove that our success and greed was our own demise. Let's go to China, the next medical device frontier, where then?  Space?  The final frontier?

The recent brouhaha regarding the medical device tax has been a joke.  The hoopla surrounding the tax resulted in AdvaMed justifying its existence (does anyone actually listen to this lame duck organization) by making statements and creating blow-charts is an embarrassment as to how the tax will impact company employees and innovation (what innovation) when companies have every intent of passing on the tax to its customers in one shape or manner. It's called creative finance. But this tax has provided medical device companies the impetus to rationalize decreasing your commissions by blaming the big bad boogie man. Let's take an example. Has anyone in the medical device industry truly questioned a company on how it can substantiate laying-off 100 employees in response to the medical device tax, and then state in a press release that there was redundancy in their job descriptions?  Even Olivier Dohuon, Smith and Nephews CEO had to back track on Joe Metzger's press release.  Hey, Joe try not stepping on your Johnson (as they say in England). The reason that no one has the "chutzpah" to question this type of response is because the same platforms that report on the industry are as complicit in their behavior as they are in shaping industry news. Let's make it positive. Let's create confidence in our marketplace.  It's the same bullshit that is regurgitated by those manipulating the stock market. How many medical device CEO's have ever made concessions in their pay or bonuses? Actually it's mind boggling there are CEO's in the spine industry managing $5-$10 million dollar companies are paying themselves a $250k salary in addition to bonuses while they manipulate investors, their employees, and their Board of Directors. But what does it say about the investors? To politicize a lame corporate decision is an embarrassment. The reason the industry behaves this way is because many of you have forgotten where you came from. You blame everyone else for the lack of innovation except yourselves. If the industry and the individuals that run these companies spent as much time on innovating as they do deal making, or bullshitting the analysts on their calls, the device would be a noble industry to work in. How ironic, August can't come fast enough.

And they we have the "new new thing" in corporate tactics that some of the smaller companies or start-ups are employing. It's called poaching your business or stealing your customers right out from underneath you, while you are a distributor or even an employee, aka "tortuous interference." The behavior of these individuals is despicable at best. Many of you even know who they are. How many of you have been involved with these characters? You know the ones that get hired as a VP of Sales and continue to keep their distributorships, bastardizing the marketplace by driving down competitive pricing. As Oliver Wendall Holmes once said, ignorance is no excuse for lack of jurisprudence. Tortuous interference is when a company or individual (we know who you are) intentionally damage(s) your contract or business relationships resulting in a loss of capital and livelihood.  Of course, some of these companies will pooh-pooh this commentary, but considering that this tort is broadly divided into two categories, one pertaining to contractual relationships and the other to business relationships, you do have legal recourse. How many of you have been duped by providing these assholes your customer information only to find out that they went out and cut their own deal by undercutting the pricing that they had established for you. Some of these people need to get their legs broken. Ethics? Integrity? The mob had more honor. Maybe the industry needs a hit squad, ey? Isn't it time to give some of the same people that you thought were your acquaintances (friends would be to nice of a word), that run these companies an old fashion ass whooping? Hell, there are even physicians that are just as complicit it doing this by collaborating with the companies that hire them as consultants. They also should be sued. TSB knows that many of you have been screwed.  Power is in numbers. You can run or you can fight, in any event, it is easier to bring together multiple parties and collectively stick the screws to these assholes.

While we are on the subject of Nuvasive, Nuvasive was recently skewered by some analysts as to how this company is being managed by a team whose time may have potentially come and gone.  It's entertaining to sit in on their analysts' call and hear "Da bear" make excuses as to how his "cheetah's" are being poached by the competition. As Warren Zevon once sang, "poor, poor, pitiful me." Excuses! Excuses! Excuses!  Even the analysts are starting to laugh.  Could time be passing this management team by? How does this team retain talent when they burn everyone out?  Even the Area VP's are stressed out. It gets funnier when Alex makes innuendos that the competition are using unsavory tactics that are not based on "innovative products or responsive customer service." Customer service? If anything, Alex is starting to run out of ideas considering he is implementing an old program called the "nuva touch."  Didn't Ma Bell have a program like that?  As for surgeons leaving for greener pastures, you know what they say on the Street, "money talks and bullshit walks." How quickly have some people forgotten who helped them get to where they are today? As for reps leaving, well let's put it this way, when you treat your people like dog meat, chew them up, burn them out and spit them out, you are always going to have employees looking for greener pastures.  I mean isn't spine all about the art of the deal? Unfortunately, the psychology of managing people is not a course requirement at many MBA programs.  As my grandpappy use to say, "you get more accomplished with sugar than you do with a flamethrower.  It's all about market conditions son!" And the market is not getting any easier.  Hospitals are attempting to redefine what free-markets constitute by keeping vendors and sales people out by creating immeasurable and ludicrous barriers.  Hey Team Cheetah, this isn't Sofamor Danek circa 1973.  If a company like Nuvasive is so confident that their technology is far superior to anything out there, why are they compelled to sue their employees when they opt to leave for greener pastures?  Not so confident, ey? It's funny how the Cheetah's running the zoo place the blame on everyone and everything else instead of their own inabilities to adjust to a changing marketplace. It would be interesting to see if Alex and Keith can survive as the Street continues to question and challenge their strategy, tactics, and excuses. Why would anyone believe that this company is prepared for its billion dollar run? As for Alex, he is a disgrace to his profession for calling out the POTUS on his conference call as a socialist. He is a poor loser, just like Vanilla ice. In business, no one wants to know your political persuasion, it's poor etiquette. Besides, if Alex is so concerned about Obamacare maybe he should move his manufacturing to his beloved Russian where they would really teach him about being critical of the government.

do svidaniya