Saturday, November 13, 2010

The Blame Game - Weekend Op-Ed

Within the last few days and weeks,  NuVasive, AlphaTec, and Trans 1, have reported quarterly earnings much to the dismay of the Street.  I guess we could give ATEC an ever so-slight reprieve for exhibiting euphoria over 2% growth. Yet, it's been a difficult year in spine, let alone the healthcare industry.   Most companies have lowered their guidance accordingly as the U.S. economy and healthcare continue to grind to a halt.  Based on the last few investor calls, it seems that the industry is revitalizing an old game called, The Blame Game.   No fellow bloggers, this isn't the game that is broadcast weekly on BBC radio hosted by Tim McGarry, nor is it the thirty minute 1999 MTV version.  Yet, as Mr. McGarry would say, "Welcome to The Blame Game, the show where there are more cheap shots than at a student union bar."  The victim is corporate America.   The culprit is?  Corporate America.  The enemy is the Big Bad Insurance Industry.  Today, spine stands at the proverbial fork in the road, and anyone that appreciates baseball would know the old Yogism, when you come to the fork in the road, take it.  So we must ask our bloggers is, whom do we blame for this temporary potentially permanent derailment?

CEO's like Dvorak, Lukianov, Randall, and Kuyper must be reading each others press clippings.  I mean imitation is the highest form or flattery, yet it breeds indifference.  The new mission statement is "our sales have been adversely affected by a higher rate of insurance denials for lumbar surgery."  These fellas must be practicing Ohm's law, whereby the current through a conductor between two points is directly proportional to the potential difference across two points and inversely proportional to the resistance between them.  Playing the blame game , or the crying game never works.  It's a proven fact that  people who blame others for their mistakes or failures usually lose face, or status, and, eventually perform worse than if they "fess up" to their failures.  For argument's sake, let's say that we are in for a rough ride over the next few years, are we going to become an industry of excuses?  If so, will this stunt our already declining ability in being creative and innovative, eventually reducing our productive risk taking?  Could it be that there is a blame virus being spread throughout the industry?  Remember the old saying you can't make Beef Wellington out of Bullshit.

The germ that these so-called leaders are spreading is protecting one's ego and more importantly one's self.  This germ may be going viral.  These difficult times will either bring out the best or the worst characteristic traits in these people.  Hopefully, the industry as a whole is learning something about itself, like how to avoid making some of the same mistakes that we have made, by putting ourselves in this position.  Complacency is sinister.  The temptation is to point your finger at someone else.  Could these individuals be showing signs of insecurity, a chink in their armor?  Truly powerful leaders are man enough, or woman enough, to state, "the buck stops here."  It's time to redirect your organizations.  But the question is, do you have the ability to think out of the box, now that you have become slaves to the Street?   That's the question that many of these leaders must answer.  Are they willing to roll the dice and force the shareholders of these companies to make short-term sacrifices to preserve their long-term viability?  Could the Blame Game create a cascading effect?

It's actually entertaining to listen to some of these power players discuss educating and working with the insurance industry.  How much more do you want to kiss the ass of an industry that rapes and pillages healthcare.  Rather than kissing the ass of the insurance industry, maybe its time to mobilize against it.  But then playing the blame game, is no different than playing the crying game, and you know what Boy George sang;

Why there are heartaches, why there are tears, and what to do to stop feeling blue when love disappears.........

So the legacy companies will re-align their guidance and eat some humble pie, while the start-ups and early-growth stage companies will downsize their sales force, cut the budgets on research and development, surgeon training and travel.  Sounds like some people are looking for survival, could be an appetite for destruction

Welcome to the jungle we got fun and games
We got everything you want
Honey we know the names
We are the people that can find whatever you may need
If you got the money honey We got your disease
In the jungle, Welcome to the jungle, watch it bring it to your knees

44 comments:

  1. I wondr how the learders of companies such as ATEC, or Theken feel when they sign up a new distributor when they know that they are in direct competition with them by supporting PODs. In AZ, ATEC is working with Archus (or whatever their name is this week, that's a whole different story)Medical, to cut out independent disributors, in order to sell directly to small surgeon groups.

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  2. they did the same in Illinois with Spinal Soltions. Thats the only way that the dynamic duo know how to build an organization.

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  3. on another note:

    >200 followers

    We must really like that blue suit, red cape, industry info and plethora of music references. Keep it up, MM.

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  4. TSON has larger problems than the others. Their procedure while holding promise, is still considered experimental. Randall only compounds the problem by bringing on managers who have zero spine experience. Urology, trauma, anesthesia??

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  5. to 8:26am....if you can't bring the business to ATEC or Theken or whatever manufacturer, do you deserve the right to that surgeon or hospital forever, in perpetuity? Your job doesn't come with an automatic annuity. The manufacturer wants growth, especially in these times; not service agents pulling down this annuity. If you can't deliver the surgeon's business, then get out of the way. The industry is bigger than the middleman. Your response will certainly frame you, so be constructive. We need thinkers and creative action; not dinosaurs.

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  6. Get freakin' serious, you must be a manager. When you state that our job is to deliver the surgeon's business you must mean consultants or guys that are getting paid under the table. That's the only way you get immediate results. What are you selling, another pedicle screw, another cervical plate, a piece of plastic? Just because you made it, doesn't mean everyone wants to use it. If you drank the kool-aid and made all those ridiculous forecasts and promises to get your job doesn't mean that everyone is incompetent, it means you are incompetent. Stop with the machismo, you sound like some investor who thinks that just because he has money he knows what he is talking about. Whomever said annuity? We expect to get paid for our time something that many of you forgot because you're still living in the past. It cost money to put gas in my car, it cost money to buy fat employees lunch, you sound like Jack Welch. We should work for free to prove ourselves. Are you getting paid a salary old wise one? The market has changed. It's saturated with more crap than ever before, where do you live in a cave? Just another mercenary talking up more nonsense. Get real dude!

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  7. Mmmmmmmmmmm, Beef Wellington!

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  8. 140 your an idiot. BOD

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  9. bet 8:26 is one of ATEC's whinning bald dudes in AZ

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  10. listen Spine Blogger. There are some things that someone with rock appreciation DO NOT DO. And the highest on the list would be to make a quick jump from Boy George (EWWW) to Guns and Roses. For shame.

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  11. You're right. I'll skate over to the penalty box this morning and take a two-minutes penalty for lack of judgement. Thnx

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  12. to "spine whine" is to act surprised about which there should be NO surprise. To have grossly ignored the underlying meaning of the new health legislation is to be negligent.

    In essence the healthcare legislation says..."if YOU really want it ...YOU are going to pony up for it",,,plain and simple...now, of course everyone is hiding behind 'comparative effectiveness", "% of GDP", "tort risks"...and on and on...unfortunately, procedures such as back surgery are front and center...to the forthcoming new norm...."fine..if you want it...you can pay for it"...

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  13. Discectomy, decompression and fusion (for the degenerative spine). All don`t require anything product wise too special, and have the most research proving it`s effectiveness.

    Gonna get back to basics
    Guess I'll start it up again
    I'm falling' from the ceiling
    You're falling from the sky now and then
    Maybe you were shot down in pieces

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  14. Nothing like Recovering the Satellites. The CC's just headlined a DB investors meeting in Phoenix, awesome showing as usual.

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  15. I use to read this blog site in order to gain an insight into what's happening in he industry. It appears that "we" have a bunch of immature, foul mouthed individuals as competition. False bravado statements, and unprofessionalisional comments do nothing to us except make the authors "look" like snively, immature adolescents that don't deserve to work in healthcare.

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  16. Like a Monday morning QB, you offer some peanut gallery commentary without offering some alternative course of action that could be taken by said CEO's. Not sure about the other companies, but Nuvasive has done a great job in navigating thru very treacherous waters. The XLIF was unfairly labeled experimental as it is merely a safer and less disruptive lateral approach. Lateral approaches for fusion that are open, i.e. corpectomy, have not been challenged nor have ALIF's. XLIF is not fundamentally different. So kudos to them for rallying the support of NASS and other groups to have that experimental tag removed. The new constrictions by insurers have to do with documenting instability and surgeons are now getting the appropriate pre-op films. None of the insurers indicated they were changing their requirements so there was an understandable slow down. Now if you are with a company that is not insightful enough to spend the money on R&D for new and more effective procedures and the subsequent cost to train surgeons, then yes, blaming insurance companies would be a cop out. But your criticism is off base by putting Lukianov in that category. Quite the contrary, he and his team have done an admirable job in procedural development and reimbursement fulfillment. The same can't be said for the big 3 and Lumbar TDR a few years back.

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  17. Question: Why would I offer any solutions, if I am not getting paid for it? Do you work for free? You're absolutely correct, NuVasive has done a great job. Have you ever read where TSB has hammered them like some other companies? NO. The gist of the post is that a leader cannot make excuses, a leader is supposed to figure how to mobilize the troops while weathering an all out assault on the outpost. I personally like AL, but this is where the rubber meets the road, so we'll find out what he's really made out of during difficult times. Everyone looks like a shining star when the market is hot, it's when you're faced with adversity that either brings out the best or worst in any individual. JMHO

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  18. To put things in perspective, all of you bleaters should dust off your Spines and read. That includes you, TSB.

    "Long-term Outcomes of Lumbar Fusion Among Workers' Compensation Subjects: An Historical Cohort Study

    A total of 725 lumbar fusion cases were compared to 725 controls who were randomly selected from a pool of WC subjects with chronic low back pain diagnoses with dates of injury between January 1, 1999 and December 31, 2001.

    Conclusion: Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a WC setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor RTW status."

    (C) 2010 Lippincott Williams & Wilkins, Inc.

    and:

    "Mortality After Lumbar Fusion Surgery"

    © 2009 Lippincott Williams & Wilkins, Inc

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  19. TSB:

    Humble my ass! "rubber meets the road", what a bunch of BS. What do you know about running a large growth company anyway? Inform us of your experience in doing so. Driving a bus does not count.

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  20. Blah! Blah! Blah! Blah! What do you think it takes a rocket scientist to run some of these companies? It's takes people to run a company, one man doesn't do it all. Get serious 10:30 you're driveling like a corporatista.

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  21. 9:13 - Thank you, great piece of information for the indoctrinated spine bunch who think they are working in highly innovative field. Spine, is merely a trumped up marketeting and sales environment with very little concern for patient outcomes. Compare spinal surgical interventions to other countries like the UK and other parts of Europe - far less, they adopt the conservative approach as they generally follow researched based medicine (although still debatable), not the American Spinal Hype Way.

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  22. this blog has become meaningless

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  23. 10:01- truly meaningless, unless you like to discuss music and famous movie quotes. LOL

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  24. Dud 10:01 and 11:45

    It's my blog, and I must say respectfully, if you don't like my writing style or opinions, you have the FREEDOM to express your opinion (1st Amendment), or, not to even read it...... You pay for cable TV even though 90% of the content is crap, don't you? At least this blog is free, takes a position on issues and challenges that affect the industry, unlike the other platforms that cut and paste from Yahoo or Google finance..... Believe me, as respectful as I am of your opinion, don't think I am losing any sleep over it. Believe me when I tell you that the sun will rise and the moon will set without your readership tomorrow morning.

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  25. If you feel it's meaningless then stop posting your garbage...keep up the good work here on the blog!

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  26. MM - Your blog is the bomb. Keep bringing it!

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  27. The ranks are thinning anyhow, just as the business numbers...

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  28. Actually, readership has been on the rise. No need making up numbers we know how many viewers, unique followers, and return readers we have, we don't need to make them up.

    "The reports of my death are highly exaggerated"
    -Mark Twain

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  29. What was meant is the employment in the industry, which does tie in to potential readership....

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  30. Spinal Solutions in IL is no longer surgeon owned and hasn't been for almost 2 years now.

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  31. Hey 9:13PM - any study done on Workers Comp patients is useless. That's like saying, "we went down to the crack house to calculate the percentage of Americans addicted to drugs and found that percentage to be very high..."

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  32. 9:13, can't imagine filleting all the posterior muscles off a patient and retracting them for 6 hours would result in anything different.

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  33. 6:35 is obviously part of Spinal Solutions in IL. What a crock...You can shuffle the deck however you want, the spades will still be spades. Nobody respects you.

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  34. Its called the Jersey Shuffle! Ha! Pinheads or Patriots??

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  35. Here's 9.13

    7.17 am. You are dead right, the rate of spine surgery in Europe is 50 to 60% below the rates here. I let you guess what the most likely cause for this difference is...

    7:50 pm, quite derogatory, your remark, and you obviously are not even capable of reading and understanding the short blurb that was posted. It was a comparison of WC patients who did or did not get surgery for the same diagnosis, so it's pretty much apples to apples, even though you prefer to call them all rotten.

    7:34 am, you're making assumptions which if you were to read the article are not necessarily true. 15% was anterior only, and 53% single level posterior, which even at a teaching insititution should not take 6 hours. So, read before you react.

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  36. 7:46 actually I am a surgeon and was concerned as well that they were surgeon owned. I was still hearing chatter from people such as yourself accusing them as being surgeon owned. I called them out on it and they provided me a legal ownership document and a copy of tax returns to prove their are no surgeon owners anymore. I would suggest you do the same to avoid mistakenly misleading people in the industry especially surgeons like myself. This could hurt your credibility. Take it for what it is worth.

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  37. 941 I am not 746. Where there is smoke there is fire and it aint the POD. Shame, shame everyone knows your game...White collar conservative flashin down the street, pointing that plastic finger at me, they all assume my kind will drop and die, but I'm gonna wave my freak flag high.

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  38. 941 - They must have some really good products and an excellent service reputation. How do you get to the point of them having to produce tax returns? I don't buy the story. Their presentation must have been outstanding. Are you sure you are a doctor? How did that meeting go: "Thanks for coming in, no need to bring me any data on your products, but a copy of your tax returns would suffice." I agree with the the others, sounds fishy. Did you start using their products?

    They might be singing Alice in Chains-

    I'm the dog that gets beat
    Shove my nose in Sh1t!
    Wont you come and save me, save me.

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  39. 9:41 That is one of the Dumbest things I have heard. If you are in fact a surgeon ummmm.... Where do you practice? The public needs to know.
    Good luck to you.

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  40. Look, I was just offering what I thought was good insight for you to look into as I did after hearing guys like yourself spreading this rumor about them. To be quite honest, with all the surgeon envy and jealousy going on amongst our peers, I thought it was very professional of them to willingly clarify, be upfront, and put to bed these accusations. Again, take it for what it's worth and go sell my man!

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  41. A little off the subject, however it's interesting to note.....Alphatec is outsourcing surgical instruments to China - GOOD LUCK if you are an end user.

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  42. 9:13,
    Read your article. There is no way you can say fusion is bad/ineffective based on any WC study, regardless if it is against other WC patients not receiving fusion. In WC cases, LOP attorneys, the doctors and ultimately, the patients involved in the case will all BENEFIT if there are complications from the fusion/surgery as complications always result in a higher settlement. So like Chris Berman says, Come On, Man!!

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  43. 10:27.

    Thanks for reading! I'm not sure I completely agree with your point of view, but will admit it is a possibility. In your view, which doctors are the beneficiaries? The surgeons who cut them anyhow? That would explain why WC patients still make up a healthy percentage of the surgical population and at the same time paint an extremely cynical and defeatist view of our world. Hippocrates is spinning in his grave.

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  44. should i start thomas jones or shonne greene as my 2nd running back this weekend?

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