Friday, April 8, 2011

Spine Blogger Survey

Is Dr. Steinmann's, aka patient zero, POD model just the tip of the ICEBERG?  How many companies are utilizing this model?  How many surgeons are involved in these ventures?  In terms of dollars, how big are some of these entities?  TSB and a colleague were discussing the rise of Physician Owned Distributorships and how it is affecting everyone's ability to earn a living.  Contrary to others opinions, many industry people believe that what we are witnessing is a fundamental breakdown in competitive boundaries in business principles.  Is this just the beginning of the end?  Do Medtronic, Stryker, Zimmer, Synthes, K2M, DePuy, and NuVasive truly condone hinging their futures on this model?  And if so, does this bode well for investors?   How badly are the POD's cutting into some companies margins?  Are some of these POD's really saving the hospital's money, or are they just shifting the profits from the companies into the pockets of the surgeons?  Are the big boys succumbing to pressures from smaller companies?  Has this industry become the poster child for an "anything goes industry?"  Will there be a decline in the need for sales people, and have we evolved into a "coverboy or covergirl" model?  Some will think that these observations are esoteric, yet, the by product of the spine boom in the early part of the turn of the century has made this industry look like more like teenage wasteland than ever before.

As TSB was interviewing some former Blackstone employees, those employees were reminiscing about the good old days when the Three Amigos were cutting deals with surgeons and mandating that distributor principals agree to 50/50 consulting agreements.  Unbeknownst to some distributors, the Amigos would come into their territory in the dead of night, meet with the surgeon du jour, and then inform the distributor that a deal was done.  The result, you pay 50% of the consulting and I pay 50% of the consulting fee.  Some argue that this model still exists, the only difference is that after years of consulting with attorneys specializing in Stark, the language and compliance protocol has been refined to smooth over the edges.

How does this model really help the patient?  Slowly, many layers of veneer have been peeled off the healthcare industry.  What we have today, is a cross between a dystopia and a grifter society.  Dysfunctional truly doesn't define the industry?  Does the industry have no one to blame but itself for what we have evolved into?  We behave no different than the former Mayor of Chicago, who under sold off the parking meters in the City of Chicago to a foreign entity, no different than the former Governor of Pennsylvania who attempted to sell off the Pennsylvania Turnpike to an Arab consortium.When you read stories about surgeons like Dr. Makker and research all of the lawsuits filed against him, one has to wonder, how many of these procedures were influenced by greed, or by clinical necessity?  And what about the patient?  So in closing, TSB wants to know who are these POD's, which companies are building their futures on this model, and will the carousel of life continue to spin round and round like the painted ponies that go up and down?

126 comments:

  1. How about Distributor Owned Physician-ships (DOPs)?

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  2. Is just the start of POD's but the big boys will have to get in it or they will continue to lose market share, the POD's is no different then big groups having there own surgery center they are even doing TLIF's in these surgery centers instead of hospitals.

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  3. Stab'l Spine in Utah-$80 Million POD. The surgeons aren't paid commission, they split the profits in the form of dividends. They have surgeons spread across the country with a strong presence in the upper Midwest. The question I have is: if this is so above board, why won't they use these products on Medicare patients? I guess I shouldn't complain, at least I get the Medicare scraps....

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  4. It is not the same as having their own surgery center. There are safe harbors, or exceptions that allow for surgeons to have ownership in center medical facilities, like MRI scanners, outpatient surgery centers, etc. There are also safe harbors that allow physicians to own a device company or distributorship, but there are limitations and I would doubt many of the POD models fall within those limitations. Case law states that if a single purpose of the arrangement is financial remuneration, then the entity is illegal, even if abuse is not present.

    As for Dr. Steinmann, I have read his comments and opinions in various places and while he tries to make a good case for the fact that the hospital is saving money and that his utilization did not go up, he doesn't answer the relevant questions about the percentage ownership, the percentage of sales derived from surgeon investors and he certainly won't admit that a single purpose of the arrangement is to line his pocket. His partner did admit to this in a video aimed at selling the model to other physicians. Link below.

    http://www.linkedin.com/news?viewArticle=&articleID=394007509&gid=1833653&type=member&item=45137512&articleURL=http%3A%2F%2Fvimeo%2Ecom%2F19947714&urlhash=TR6w

    I would also ask him that if cost savings are his primary objective, if I were to offer my products at 15% below what he is charging, would he immediately convert everything.

    There is obviously the story he puts out for the masses, and I am certain there is a bit of a different story if one were to ask the reps that cover his area, the nurses is his OR and his accountant. I would love to hear from some of these people.

    I have looked at some of the numbers he cites and they don't add up. He also tries to demonize the reps alleging making ridiculous statements about what they make (as if it were relevant) and trying to claim that implant companies have 15% price increases yearly. That simply proves that he has an agenda and is justifying his position (with untruths, shall we say).

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  5. The problem runs deeper. In the present system, the choice of therapy is not made based on what would be the best option for a given diagnosis and patient, but which one brings in the most money. In spine, many patients would do equally well, if not better, if they would get non-operative therapy instead of surgery. Instead, 85 year olds are sliced open and 30,000 dollars worth of implants stuck in them. If they get out after overcoming the complications, which are common, they rarely do better. Of course, if they are younger, you can always try again, and again, and again, mostly with the same bad results. (You listening, Makker??). The POD's further compound the issue as now the surgeon not only gets his surgery fee, but also a percentage of the 30,000. It may be legal, but it certainly is not ethical, and devoid of any common decency. The fact that over the past few years the average income of spine surgeons has dropped from really obscene to just obscene is poor justification. My next job will be in pediatrics.

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  6. @5:36, are you really the rep getting "the Medicare scraps" or just trying to get that rep's business? I'll guess the latter.

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  7. There is no question the hospitals arent saving much money, its just a transfer of profits. Its going to be nice to see a hammer come down on some of these unethical practices called POD's. Lets see you use the product and you get direct commission off of it, im sure there is no incentive there to use more, right doc. If the DOJ doesnt do anything about it, there will be plenty of work for plaintiff attorneys for a long time suing on behalf of the patients for unnecessasry surgeries. And from the previous post, if they arent using them on medicare, that pretty much tells you how illegal it is.

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  8. It will all be over on December 21st 2012...

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  9. They don't implant on Medicare because the rules change drastically when it comes to Medicare patients and surgeons POD's. This is actually the only way to operate in the positive area of what is still very much a gray area.

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  10. By the way as an insider in Chicago, Daley only stepped down because now he can reap the dollars from that private company he gave the meters too....which he will be involved with now. He couldn't collect any money from it as mayor!

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  11. Mayor Daley, a true grifter who wraps himself in the American flag. People should spit on that guy when they see him in public.

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  12. Medicare or not, if the surgeon is looking out for the best interest of their patient they would use the best product on every patient. That would be an easy argument in court, but not to use it bc of medicare rules and regs just says I can be illegal with private paying patients and legal with medicare patients.

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  13. PODs are clearly illegal and unethical. No doubt about it. The problem is that the DOJ is asleep at the wheel. The DOJ are incompetent government lackies who are too lazy to do their jobs. Any companies who are selling to PODs are doing so because they are forced into it. Its either loose the business altogether or take a hair cut with a POD. Until the DOJ is forced to do their jobs, unethical surgeons will continue to join PODs with familiar excuses of "declining income", "saving the hospital money", etc. etc. Basically, POD surgeons are sucking ALL the money from sales reps and most of the margin from companies. The DOJ is awful to let an entire industry go into a tail spin by POD organized crime.

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  14. POD's are not clearly illegal. Nor are they clearly legal. Do your homework! It's a GRAY area!

    And for the person who recommends spitting on Mayor Daley I would dare you too. You would be dead, literally bro! Careful on that one. He is a well connected man that would make u disappear and nothing your friends and family could do about it.

    Check out all the press trying to prosecute his nephew for a fight back a couple years ago that killed a kid. No one will touch it!

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  15. I know of one POD in town that is definitely not saving the hospital money. They are getting $2300 for a 2 level plate at the surgery center the doc owns. That's a triple dip....

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  16. POD's are illegal, there is no grey area about it. If anyone with half a brain can read the stark and antikickback laws its clear as day that these POD's are illegal, the time is coming these types of entities will go down and hopefully most will go to jail.

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  17. 8:29 you are wrong. Ask any attorney and they will tell you it's a "gray area". Even the OIG told us that when we went for an opinion.

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  18. Yeah I did ask an attorney and they said it was illegal, clearly, no gray about it. You can find an attorney who will tell you what you want to hear, there are plenty of unethical attorneys as there are doctors out there. We will see what happens, because it is coming. The POD's out there are making it an easy target for the DOJ, everytime one pops up, thats more money the feds will end up getting when all this is over with, no doubt about it. It will be interesting to see if anyone goes to jail, thats the big question.

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  19. I have a problem with this statement, "affecting everyone's ability to earn a living." I guarantee that there are no great sales people out there that have a problem earning a living. Are the good ones maybe earning less? Of course, but I am not going to cry about you making $175k vs. $250k. The people that are hurt most with the PODs are the ones that can't sell without a shady deal of their own.

    The PODs have the same root problem as the poor/shady distributor, and that is why the big companies (and many small ones) won't touch them. It is not a sustainable business model. Eventually, the PODs will end and eventually the poor sales people will have to find a living elsewhere.

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    1. As a 20 year Vet in Spine I agree with this statement 100%! Live by the sword, die by the sword. Those with true acuity and skill will always survive. The issue in our industry today is that we hire big boobs and no brain as opposed to true skill. Shame on us!

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  20. What everyone seems to be forgetting is that the antikickback (Stark) rules only apply to federally funded, i.e. Medicare, patients. As has been mentioned, most PODs already exclude Medicare patients for this reason.

    Therefore, even if the OIG came out and said PODs were illegal tomorrow, it would really have little effect on most PODs. The OIG/DOJ only has jurisdiction over federal patients. So PODs are here to stay folks, like it or not.

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  21. Remember greed is inherent to human nature, eventually some cutter like a Dr. Makker, the poster boy for NASS, will start pushing the envelop and not distinguishing Medicare patients and the party will be on...... don't be so full of yourself, sooner or later someone steps on their own d*#k, or as Gordon Gekko said, greed is good until you do something stupid

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  22. Remember that physicians if they except medicare patients into their practice they have to treat them the same as non-medicare patients. I have a tough time believing that the doc's in POD don't except Medicare patients at all. I would like to know how they justify using a different company for their medicare patients? I believe this is where the DOJ will prevail and you will see that the doc's are not so smart nor are the attorneys who advised them. Honestly, the only ones who will win are the business people/rep who set up the POD, as long as the doc is not using the same equipment but under another company name with the same business people/rep for the medicare patients. If they are then the rep will be up shit creek as well because the hole thing is a sham. When the DOJ comes a knocking they will have to have an excellent story as to why they are treating medicare patients differently. There are plenty of rat bag doctors who testify for a living that will rat out here colleagues and say there is no difference in the implants used for the medicare and non-medicare patients.

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  23. 10:27am, very well said and very true. Why are they treating medicare patients differently? Seems to me the docs would want to help their medicare patients on that huge cost savings they are doing with their private patients. or is is there something else to the story.

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  24. 10:27

    Actually a lot of docs are giving up on Medicare patients. The physician reimbursment is already very low and there is talk of another major cut next year. Taking Medicare patients barely covers a docs overhead.

    For the financially-motivated surgeon (lets be frank), he can be better off dumping Medicare and concentrate on his double-dip POD patients. Half the work, twice the money. I'm not saying its right, but it's being done.

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  25. You all want PODs to go they hurt your ability to earn a living. Your the same ones that hire the surgeons brother to do his cases. That is the area they are sloppy and dont differentiate private and medicare. Both groups PODs and dirtball distributors need to go before the industry levels. Call out these dirtbag distributors paying the family members of the doctors. Names, names, and companys...

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  26. If you remember back to the genesis of the Stark laws, as I recall, they were a result of the proliferation of MRI centers. When MRI's first came out they were great, new and very expensive technology. Once the market matured and the businessmen got involved they had an epipheny! Why don't we get the doctors to put up their money to buy the magnets? If the docs put up the money, surely they will refer all of their patients to our (and their) MRI facility!!

    End result......an explosion in the number of MRI centers and number of MRI's being ordered on patients. The result of that was Pete Stark initiating and passing legislation banning physician ownership of MRI facilities.

    Now we just need the same thing to happen to POD's. Think about it, at least with the MRI centers the docs had to invest hard dollars. I am not completely sure, but the POD's don't even require any upfront cash to my knowledge other than setting up the new legal entity. Any way you slice it, it is self referral (no pun intended) and at the very least this must be disclosed by law to the patients.

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  27. Is this why you got into medicine? To find as many "gray areas" as you could to make cash? Your patients are real people, with families, kids, ambitions. Concentrate on what would really be best for them, not how much money it's going to make you.

    - Your conscience ( remember me)

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  28. I blame the companies supplying the POD's just as much as the doctors. I remember taking several business ethics classes in college, and I think the CEO's of several companies need a refresher course. Just because it's legal or grey doesn't make it right. Companies like Alphatec will do far worse for their shareholders when the WSJ breaks the story of Dr. Makker and the Omega POD. If you think the DOJ is going to crack down you are wrong. It will be the public outcry when the media gets a hold of it.........and they will. It's a ticking time bomb that even Jack Bauer can't diffuse.

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  29. I'm living the dream but I do wonder, why didn't I invent reptrax !?


    vendormate sounds kind of not hetero, wouldn't you agree ?

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  30. Heard Sendro is leading the chargwe at Amedica, can you say DOJ all the way

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  31. Stab'l Spine aka Archus Medical aka Mesa Medical...hmmmmmm Why would a legit company have to change their names so much? Maybe its to confuse the DOJ? In an interesting rn of fate, the hospital I do most of my cases at sent a letter to all distributors. We were "asked " what % do surgeons own of are companys....Wording goes on to state that the OIG has "concerns"....And mgmnt states that if a new vendor wants to come in, and if surgeons "own any part" they won't be allowed in.....It's a start......

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  32. 4:46


    Can you say what state you are in?

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  33. Carl Hiassen couldn'tve written the Blackstone story...

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  34. Does anyone think Globus will go public?

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  35. 11:01 most of the surgeons in my area still have ownership in an MRI company, the issue with any physician owned companies is risk, according to the bylaws if a surgeon is a partner in a company it is legal if there is some type of risk, that is why PODs are legal, they are buying inventory to create risk, they are stocking distributors. I am a rep losing business to PODs, so I am not an advocate for them but they are legal, there is no grey area. I have surgeons who have ownership in the neuromonitoring company they use as well. This is the future, Surgeons are looking for every avenue to make more money. Their argument is that other industries do it so why can't they. I understand that it is someones family member that is on the table but they look at it as a job. The reason that the DOJ has not made more of an impact is that the big boys are afraid that it is legal and it will get worse if the DOJ gives the green light. I love my job and I work hard at staying above board but I think we have to look in the mirror and be honest, PODs are here to stay and we have to adapt to them. There will be a time where we will be needed and the cream will rise to the top. Good luck selling.

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  36. @ 3:15.....nice jack bauer reference....solid!

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  37. who is asking about globus going public in every post, do you have some stock to sell, you must be a surgeon.

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  38. 3:15 is right. If the public only knew.

    F globus. Guy that keeps asking about going public is a ra-tard.

    Who else billed over 400 tho this month besides me?

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  39. South Texas, home of the POD, just go down there and sniff around. Harrisburg, Pennsylvania, home of the Custom Spine POD run by the infamous former Globus boys L5.

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  40. Spinal USA
    2050 Executive Drive
    Pearl, MS 39208
    601-420-4244

    DOJ anyone?

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  41. 9:58 The fact that people buy business in other industries is irrelevant because those industries don't have Federal statutes in place to prevent it. If you read any opinions online, whether from OIG, lawyers specializing in Stark Law, venture capitalist or even AAOS, they ALL state that these entities are "problematic" at best, particularly distributorships (versus physician owned implant manufacturing companies).

    Read the first paragraph of the Anti-Kickback statute and see if you think it is gray area. Read the case law that states if a single purpose of a surgeon selecting 1 product or service over another is a financial remuneration of any kind OR if the possibility of inducement exists, then the entity is illegal.

    There is no way a surgeon could pass either of these tests if they own a POD. The is NO way to explain how they happened to switch all of their implant usage overnight to products sold by the POD and the reason wasn't, at least in part, financially motivated.

    The lack of anyone bringing a suit against these POD's is why they keep proliferating. Leaving it up to the OIG to make it stop is not going to work. Someone leaving the industry with nothing to lose needs to start a whistleblower suit. They could make millions.

    My understanding is that some of these groups are now using POD implants on Medicare patients in Huntsville AL. I am trying to verify this currently.

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  42. Considering what has been going on in Alabama, maybe it's time that the feds start there, and while in Alabama sniff out the company that is in bed with these POD's and expose their business practice.

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  43. I would say S. Texas was a "POD" before the word even came in vogue. Those 'red" dudes pioneered the concept.

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  44. The reality is that the present law and OIG/DOJ practices are not sufficient to stop this, at least in all cases such as private pay. Industry should fund a non-profit 501(c) group, called maybe Spine Industry Integrity Co-op (SIIC). This group would collect donations from industry and concerned surgeons. SIIC would prioritize approaches based upon available funding to include the following.

    1. SIIC would lobby for new legislation that makes the POD clearly illegal. I can't see a surgeon group publicly fighting to leave this corrupt practice in place. They would loose and loose their reputation.
    2. Fund and or set up medical malpractice groups to represent patients who have received POD implants. POD implants could be of lower quality than other implants, or at the least the surgeon is clearly more likely to do unnecessary procedures due to the POD kickback.
    3. Approach providers of medical malpractice insurance companies and educate them on the PODs and the fact that this kickback may induce poor implant choices and unnecessary surgeries. Encourage them to drop any surgeons involved in PODs, and make the surgeon participation in the practice of PODs result in policy cancellation and nonpayment of any claims presented.
    4. File suits against PODs with the aim of gaining "class action" status representing patients harmed by poor quality implants and unnecessary surgeries.
    5. File suits against PODs representing honest industry players such as manufacturers, distributors, and reps for unfair competition and torturous interference.
    6. Fund whistle blower lawsuits against PODs for Medicare and Medicaid fraud.

    Basically, we need to start and fund such a group to exterminate PODs from our industry.

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  45. Man, even the comments section is boring now. YAWN!

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  46. For all the Nuvasive blowhards who post on TSB & think that Nuvasive is immune to being acquired, perhaps you should ask yourselves why there's been only one single insider transaction (sale of stock) this year? Specifically the Bear who hasn't moved any stock since July 2010,,

    http://finance.yahoo.com/q/it?s=NUVA+Insider+Transactions

    And you think this company isn't being shopped?

    Laughing,,

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  47. Do I feel an uprising coming on?

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  48. 4:02
    DP and BA. Not even out of trouble yet from their problems with Globus and they have their hands in something else. I am happy these 2 are involved in a POD. Surgeons in the area, other than the extremely limited number they work with, will not want to touch any POD with a 10 ft. pole just because these 2 are involved with one. They are pitching a " limited window of opportunity before it becomes illegal...". Only problem, same surgeons are still waiting for their investment with Globus to someday go public...

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  49. 7:46 - you've given me a good idea. The next time I hear a doc say that their POD is intended purely to save the hospital and public money from greedy implant companies, I'm going to wonder why they didn't form it as a non-profit organization. An NPO POD makes perfect sense, and there's no COI (since there really isn't any PO either.) But an NPO PMD (Physician Managed Distributorship) would be clearly both ethical, legal, and the NPO PMD could even pay the surgeon a small salary for the time effort and energy they ACTUALLY contribute to it, thus supplementing their ever decreasing incomes. Then we'll see if they're truly underpaid when they realize what they would get paid for actually running a distributorship.

    Physician ownership of distributorships isn't "beating" greedy implant companies, it's joining them. And using their position to skim the cream off the top without the cost. It's just like many surgeon owned specialty hospitals, which exploited the high reimbursement of lucrative procedures, without having to lose money on the poorly reimbursing ones. (Gee, looks like that one ended up passing muster, didn't it?) The bottom line is unless the physician can clearly separate his personal position of decision making power to decide how someone else's money is spent from revenue generation for the company he owns, it's a COI and thus in my view unethical and likely illegal.

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  50. ... btw TSB, an update on the status of physician owned hospitals may be a good blog topic. Be good to hear what everyone else is seeing around the country.

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  51. The spine community moral meter:

    Docs owning their own hospitals...OK
    Docs referring to their own MRI...OK
    Docs selling braces to all patients...OK
    Docs referring to their own PT center...OK
    Docs fusing patients who are too old...OK
    Docs fusing patients who only need lami...OK
    Docs dispensing meds to patients...OK
    Docs doing their own neuromonitoring...OK
    Docs getting consulting agreements...OK
    Docs getting royalties on "inventions"...OK
    Docs getting speaking fees...OK
    Docs investing in a spine company...OK
    Docs investing in a spine distributor...OUTRAGE!!

    What is the difference between PODs and every other moral transgression in this murky industry? Unlike all the others, this one hits reps in the wallet. Docs have been getting away with scummy activities for a long time in spine, and the industry is now reaping what it has sown.

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  52. TSB asked: "How does this model really help the patient?" Drop the sanctimonious crap.

    How does a spine distributor flying around in a G6 really help the patient?

    As PODs have proliferated, I'm not aware of a collapse in spine surgery outcomes. If those surgeons are practicing bad medicine, they will be punished by the plaintiff's lawyers, by their licensing boards, by the hospitals and by patients who will not go to them.

    I'm not making as much as I did in 2006, 2007, 2008. Some of the docs are moving some of the chips from our side of the table to their side of the table. Don't count on the OIG to move the chips back to our side of the table. If they move chips, it won't be back to our side, it will be off the table altogether.

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  53. 9:48...As much as POD have hurt me in my territory in losing marketshare, you do have a good argument. In addition to everyone being screwed at the hands of initiatives by surgeons. Just now add spine reps to the list. It furthers my belief that regardless to all the POD "outrage" I doubt anything will actually be done about it. We can only wish.

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  54. 10:20 Is it just an issue of outcomes or of an incentive to make use of a patients trust? Add another plate, another level, cross-link etc. Was it needed? Practicing medicine.

    It happens in other areas as well. Choose an out of date patented hip design. Get it copied. The docs create a minimal company and buy from them. Legal? yes, ethical well its an old design, better items on the market. Patient is clueless and just happy his hip feels better. The patient thinks the doc is God for the relief of pain. No rep involved. The docs will always look for ways to get more.

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  55. Let me start trying to answer some of MM's questions. There are 39 PODs in Texas with approximately 75 surgeons attached to these PODs and over 400 spine surgeons in the state. What else can others add by state?

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  56. Personally, I believe the DOJ is slow to address the POD issue because there is not enough profit in it.

    By spending their time and attention on the big pharma, (e.g. Bextra, Celebrex, Vioxx) they reap hundreds of millions in fines and settlements. In comparison, what will they get from your local spine practice? Not much.

    When the DOJ attorney runs for public office, (and they all want to be senator or governor someday), he would rather his resume include being a giant killer by putting away the big, bad drug company. Who will remember/care if he put away Dr. Nick Riviera?

    Similarly, the implant manufacturers working with the POD's are small startups without much if any market cap. No money there, either! (If one of the big boys - say MDT, J&J or SYK - ever got involved, the DOJ sharks would be on them in a nanosecond.)

    Remember, these are lawyers, politicians, and bureaucrats we're talking about here!

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  57. Anyone looking forward to AANS? Should be another rivoting meeting,,

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  58. Spinal USA isnt just a POD. They manufacture what they sell.

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  59. Please Mr. Doctor please come to my booth, and look at our products, aah hell with the products let's go to Shotgun Willies. Let's saddle up our horse and ride into the City cause the girls at Shotgun Willies are pretty.

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  60. Lovin, touchin, squeezin........

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  61. Journey jumped the Shark when Greg Rolle quit.

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  62. Spinal USA. Some of Huntsville, AL finest!!! Operating at one of the hospital's that paid a stiff fine for defrauding Medicare with their Kyphoplasty billing. No, they aren't saving the hospital money ... it's all about mo' $ in their pockets. Their implants are crap. They revise them all the time.

    I agree the OIG may not take much of an interest in good 'ol Spinal USA but there are enough savy lawyers who can break these surgeons down on the stand with less than 3 questions. It's only a matter of time before a jury of their peers crushes these greedy surgeons who live beyond their means.

    Still pretty funny that Huntsville Hospital is playing with this fire again. It tells me the Hospital system is making truckloads of cash of their spine service line and are willing to look the other way (regardless of what their dipshit OR and Materials people say ... "we're losing $ on all of these implant patients!"). Kinda makes you wonder if some of the OR staff is on the Spinal USA payroll?

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  63. I'm surprised. Everyone talks like these POD's are all over. We have about 5-6 names in comments. Is this problem being over-blown? Tell me the market is still got a future or is the POD angle the way to go? if POD's who?

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  64. 7:46 Really good thoughts! I think you should add a media piece to your plan as well. Let's find out how the general public looks at this "grey area" once 20/20 or Dateline does a piece on it.

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  65. Maybe the POD's should be picking the fight with the folks that cut their pay, i.e. insurance companies/big govt, instead of trying to take a whole industry out by shifting profits from the sales reps to POD's and hide behind the fact that your saving the hospital .05% on implants and you found a lawyer that said it was ok to do. They might have made a mistake here bc most sales guys are very competitive and it looks by these comments on here they will not roll over to these POD's. So, POD's might need to get ready for a battle, which of course everyone loses in this.

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  66. You guys are looking at this all wrong..."Government, come save me!!"...The DOJ is not the group to shine a light on this. Also, let's be realistic, we have waayy too many sales reps/sales management and waaay too many of them making money they believed they earned...there will be a change to the delivery of medical devices to the end user (patient) as well as adjustment to how they are paid for (think cash)..meanwhile, I will bet a $1 that the first lawsuit will be anti competitive lawsuit from a Stryker/JNJ/Medtronic to a hospital that utilizes a POD....vs a DOJ investigation...Can't sue a doc (bad for business) but you can go after a hospital and open up their eyes to their risk....will never get to court, hospitals will start screening implant companies to see if they participate in a local POD....

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  67. 8:54

    Let's say for arguments sake that you are correct when you say, "we have too many sales people and managers making waaaaaaay too much money which they believe they earned.". Doesn't the market and competition dictate salaries the same way it dictates pricing? The same way an educated public has the option of picking one surgeon over another if they are in the right insurance plan? The same way that Wall Street rationalizes paying obscene bonuses, which by the way no one seems to bitch about, to "retain talent?" Surgeons continue to cry foul when the government threatens to decrease reimbursements, on the whole most don't even want to care for Medicare and Medicaid patients, private plans are increasingly denying lumbar procedures and whom do these raconteurs blame for the break down of a system that is methodically breaking down? Salespeople. Should we laugh now or cry later? I remember selling to general orthos and they use to bitch about podiatrists wanting to perform surgery above the ankle, crying foul. How many whiny comments have you heard from neurological spine surgeons bitching about interventional radiologists? But please don't rain on my parade. My feelings are if they want class warfare bring it on, because in the end they will only have themselves to blame for being the spoiled and greedy little brats that they are.

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  68. 8:25 I agree with you whole heartedly. 1st the hospitals have been lying to everyone(Doc's, their employees, reps and companies). The hospitals are making huge profits off of spine and even huger where they have beat the companies pricing down. They were making huge profits before they beat the pricing down. Of course, this is because the companies allow it to happen since there is always one wussy who caves in first when the hospitals propose a pricing cut so everyone then has to follow suit. The hospitals never tell you that every year they get an increase in payment from medicare and most insurance companies follow. The insurance companies then screw the Doc's with reduced fee for service, increase premiums and end up being the big winner. When the insurance companies feel, their hospital partners for now have beaten vendor pricing for devices to the lowest point, they then will have all the power. Then they can start ratcheting down the reimbursement to the hospital, eventually screwing there ex-partner in crime. Then the hospitals who are trying so hard to screw industry, while the insurance companies and medicare is taking care of screwing the doc's, will then get screwed by the insurance companies and there will be no more blood to get from the vendors, although the vendors still have to worry about the wild card wussies out there. Just wait and see. Do you think these greedy rat bastard insurance company executives want to give up anything? I think not. Check out this link: http://deep.mastersfamily.org/2009-08-12/billionaire-insurance-ceos-102k-per-hour-salaries/. The hospitals and the insurance companies are not friends of the doc's or industry. Soon enough the hospitals will not be friends of the insurance companies. the insurance companies will be the reigning king as they are now.

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  69. 9:33 Your writing style is nearly as bad as your inept grasp of the English language. While I think we are on the same side in this fight, I respectfully ask that you no longer comment. In other words, you're making us look bad.

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  70. Easy Harvard, Everyone's comments are welcome.

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  71. How come half the comments on this blog are reps that tear up the docs for their constant whining about declining reimbursement and substantially decreased salaries and yet in the other breath, they can't help but piss and moan about a few docs that don't use them any more? It is ok for the guy who takes all the risks to get paid less but the courier has to keep getting paid because he went from the frat house to a four week course in Memphis has to keep rolling in the dough. Speaking of dough...this skill qualifies most of you to deliver pizza and that is all. Seriously, live it up while you got it...but most of you will not be selling spine in five years regardless of POD's. Between Obama care and greedy hospitals...your commission and salaries will be slashed by three fourths....and don't expect the docs to stick up for you because you are so essential (we are not)...what have you ever really done for them...showed up on time...brought sandwiches to the office...maybe threw in a dinner if you had to because you saw them use another company once. It is coming....my recommendation...read a book...get a skill...and you will find a job with real security. Selling medical devices isn't it. By the way...the OIG has looked at these and found the "some" of these models are above board...not all...but under the right circumstances...just like PT, MRI, Hospitals...they are legal. Don't fool yourself.

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  72. Ouch! That hurts. But the truth always does.

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  73. Agreed 10:17am, Harvard relax this isnt an english class. I do agree the hospitals are making huge profits bc they arent doing %%%% about the POD's. If they were losing money I would guarantee you they would be crying foul. Kind of like they cry foul about surgery centers and physician owned hospitals.

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  74. 11:31am keep telling yourself these illegal POD's are legal, lets just see what happens and where did the OIG say these were legal or are you still trying to convince yourself its ok?

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  75. The biggest fallacy I have seen mentioned at least twice is an educated public. The public is clueless about healthcare. They only care when they are made to pay part of their premium. Then they only blame the insurance co.

    Want change? Villainize more then just the insurance co. and educate the public. Then again it may not be the change wanted.

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  76. I don't get why some of you guys want to put the blame for POD's on the companies that sell to the POD. As long as they are stocking distributors, and only get paid for the product (versus paying a commission or being financially involved in the POD), why do you have a gripe with them. I can understand that you see them as enablers, but that doesn't mean they are involved in the illicit aspects of the game. Obviously, the docs and the POD partners are the dirty ones and they will use anything that lines their pocket. The company they end up using is largely irrelevant to me.

    Do some of you have information that suggests the companies are financially involved in any way other that as a simple supplier? I haven't heard of this, but it wouldn't really surprise me. I know some PODs try to provide everything the docs use all the way down to the bovie. So, in your opinion, are all of those companies that sell to the POD crooked or is it just the ones that happen to sell the same products as you?

    BTW: 7:46 4/9 - You are right on track. Start a movement and I'll join. I'll even help you get organized. It would be fun to get a scumbag plaintiffs attorney hot on the trail of some scumbag doctors and POD's. I can see the billboards now! "Have you had back surgery by Dr. John Steinmann? You may be able to participate in a class action lawsuit. CAll 1-800- BAD-DOCS". LMFAO

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  77. DOJ is a self funded organization. They can just show up at a Merck or Medtronic and threaten to hang around and find something unless they agree to settle for $40M. They take the money and run, without even finding anything. Why would they go after some individual doctors. This is going to have to come from the public and/or the AANS/AAOS/NASS groups. I don't think our industry can cooperate enough to get organized and fight this.

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  78. AANS/AAOS/NASS groups won't get involved. Why? Won't they want to hold out to see if their breathren can get a POD going for themselves? Out with the old (consulting contracts) and in with the new revenue stream (POD).

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  79. 11:31 Don't be an idiot. Are you so arrogant that you think a sales person with a college education is qualified to deliver Pizza? What about a sales person with an MBA running a multi-million dollar distributorship? If I have to get out of medicine and into another industry I will succeed because my business acumen allows me to cross industry lines. If you lost your medical license, what can you fall back on? What can most of you do outside Medicine....maybe a butcher or a vet? I have the utmost respect for the surgeons I work with, and they would all agree we are valuable members of the team. You on the other hand are a complete a-hole/d-bag.

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  80. SpinalUSA in Huntsville, AL >>> Funny thing is BC/BS of Alabama has north of 80% market share of insured AL lives yet they haven't blinked an eye when it comes to paying for all of these revision surgeries with those crap implants.

    I'm sure the beancounters at BCBS of AL would quickly realize the revision rates dramatically increased after these surgeons purchased a majority stake in SpinalUSA.

    The change will come when the payors demand change. At this point, SpinalUSA isn't big enough to warrant the OIG's attention (I do agree it's amazing some medical malpractice/plantiff type lawyers haven't come after SpinalUSA)

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  81. From the OIG's 2008 Annual Report. A look at ROI shows why they will not go after individual PODs.

    In FY 2008, OIG’s contributions to safeguarding HHS programs from threats of fraud, waste, and abuse and to promoting economy, efficiency, and effectiveness in HHS programs included: • $2.35 billion in HHS receivables were court ordered or agreed to be paid through civil settlements that resulted from cases developed by OIG investigators; • $1.33 billion in audit recoveries were agreed to be pursued by HHS program managers as a result of OIG audit disallowance recommendations; • the return on investment measuring the efficiency of OIG’s health care oversight efforts continued its trend of increasing returns and reached $17 to $1 in the reporting period ending in FY 2008; and • HHS program managers accepted and agreed to implement 85 of OIG’s quality and management improvement recommendations.

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  82. All very interesting. What is the name of the distributor flying in a G6? That kind of over the top, rub your nose in it arrogance deserves to be outed.

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  83. another opinion, for whatever it is worth

    http://www.hoganlovells.com/files/upload/PODWhitePaper_Nov2009.pdf

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  84. "

    Anonymous said...
    How about Distributor Owned Physician-ships (DOPs)?

    April 8, 2011 5:29 AM
    "

    ----

    Suprised this didn't get more responses. Fundamentally, I don't see how a manufacturer/distributor paying a surgeon a "consulting" fee for using thier metal is any different than POD's. Arguably (which I'm sure others will take me up on), the POD model could be considered more transparent. At the end of the day, the dishonest Makker's of the world will line thier pockets in whatever the scheme du jour happens to be.

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  85. All you think that PODS are the anti-Christ of medicine yet companies like Depuy can "once again' get caught paying off people and pay crazy fines for kickback schemes and fraud and these payola surgeons still use their stuff because they are Depuy/ J&J. Guys like Heary, Giordano, Bhatnagar, Lospinuso, and all the other payroll surgeons in Depuy's NJ/PA group who Close gets special "$$treatment$$" for all get a piece of the action and nothing happens. Depuy pays millions in fines and is a so called good company and the patients get defrauded because the dirty surgeons only use what they get paid to use. Is this untrue? Am I telling a fable? So lets beat up on PODS because they are so, so bad....and all this other crap doesn't happen behind the scenes....it would be laughable if it wasn't so intellectually dishonest.

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  86. But here's the kicker, the companies and surgeons continue to game the system. So when the Medicare hammer finally comes down, and the insurance industry bend you over one last time like the little choir boys and girls that you are, you'll have no one else to blame but yourselves. At that point you'll have blown your chance to stand up and be counted. Remember, you chose your profession, no one stuck a gun to your head unless you were trying to please mommy and daddy. Don't bitch at the sales people that you are getting treated like second class citizens. You all talk a big game, but you're all a bunch of P*SS*#S when it comes to a fight. The most divisive, envious and greedy profession outside of Wall Street, being a doctor.

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  87. 12:22- so where is the basis for this ? any proof of these consulting agreements? Is Stryker or Medtronic or Nuvasive completely free of agreements? Name a company who has zero consultants.
    why the Depuy attack?

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  88. Gotta admit, some very questionable relationships by me not only with surgeons, but the " OR Spine Gatekeepers" !!!!! How do they get to go on company trips or to places their surgeons speak at!!

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  89. Depuy that is...

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  90. All companies have their weak spots when it comes to following a moral compass. The big companies invented the consulting agreement and then pushed it to the point of being criminal. I believe the royalty agreement is next. How can you use any objective algorithm to place a value on intellectual property. You could theoretically give fractional percentages to hundreds of surgeons that had any tiny suggestion in the development of the next generation Legacy or expedium screw. How can you pursue that legally. They could then justify paying those surgeons for the useful life of the product without being questioned and the docs don't have to do anything to keep getting the check.

    Smaller companies use the IP and consulting route as well, just not spread over such a huge stable of surgeons. The smaller guys are much more likely to participate in selling to POD's, brokering surgeons thru a rep that is willing to flop companies, set up territories based on surgeons instead of geography (essentially making every individual rep a distributor) and they have more than their share of shady distributors.

    No company is completely above board anymore. At least it seems that way to me. But it always takes 2 to tango so there are equal numbers of surgeons that are more interested in the benjamins than the patient (just like ALL of the companies).

    I don't see the DOJ bringing these POD's down, its going to take some ballsy reps to blow the whistle to plaintiffs attorneys and news crews to get some negative attention on the doctors and maybe they will get nervous and walk away from the risk.

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  91. 7:20

    What do you know about the suppliers business practice? Which POD is it? Are they involved as partners in the POD or just as a supplier?

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  92. why dont all you wusseys start naming names/territories. Man up bitches...

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  93. My Company always asks you to ask yourself the following question: Would you, if your behavior was accurately reported in the newspaper, be embarrassed? If so, what you did is probably wrong. You can call it a gray area and say it's not "technically illegal". Tell yourself whatever you need to to feel OK. It doesn't make you any less of a scumbag. The POD model is for scumbags, and the hammer is coming down... Eventually.

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  94. Sounds like someone got their ass kicked by DePuy.

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  95. 5:57pm So let me portray what you (the rep) does for a living in my local newspaper....my rep puts on appearances that every waking moment that his value-driven life is for the patient and he must put up with the difficult doctors and hospital people. He also goes to train on stuff that many could do given the chance and hard work. For this, he feels he owns my business and earns $250 to 500K annually while his boss earns at least that much from my business. Well is that accurate enough. It could have been a lot more details, but I think the reading public would be sickened. You embarrassed.

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  96. Hey 9:53 and 12:22, the difference between a consulting agreement and a POD is that a consulting agreement can be a "quid quo pro" kickback, but a POD by definition is one. There are plenty of legitimate consulting agreements out there, and some illegitimate ones. As 5:57 points out, the litmus test is whether it is "buying business" or buying what the consultant can offer (which can be ideas, design review, research, etc., and arguably even simple promotion or endorsement support). And there are many consultants for companies who don't give all or even most of their business to the companies they consult for. (Especially those with a laundry list of consulting agreements.)

    But as the H&H white paper points out, there is no possible way that a POD can avoid creating a direct conflict of interest as long as the surgeon stands to gain financially from the implant choices he personally makes. And that's the difference.

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  97. 5:24PM --- "...What can most of you do outside Medicine....maybe a butcher or a vet?" I wouldn't let a good 50 % of surgeons I deal with operate on my dog. That is one of the kickers of this field. We all know the docs to go too if we needed a procedure and it is probably limited to a handful. As the joke goes, what do they call the last guy to graduate med school. Doctor.

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  98. 6:11 - Stop worrying about other people's paychecks. We don't give a crap how much you make. If you make $5 million/yr good for you.

    How many spine reps are still making $250 to $500K annually? I would guess that most are in the $100 to $200 range.

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  99. Whomever is the surgeon that is constantly bashing sales reps has a distorted perception of what the average sales rep earns. Maybe some of the Danek distributors in Atlanta, Phoenix (is he even there anymore), and Colorado earn beaucoup dollars, but those individuals are running a company that EMPLOYS people, just like Dr. Famous. Why do surgeons even give a rats ass what sales people earn? If you really believe that we are driving up the cost of healthcare, ask yourself this question, whom do you think pays for your consulting agreements? The cost is passed on to the hospital, the insurance companies, and the patient. QED

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  100. I am a invester in the spine arena, and the one thing i can say is you guys sure keep your enemies close. Its almost comical how you guy's speak of one another, and the jealousy that pours into your typing is completly noticable. Im guessing most of you know who you are just from your words, i just hope the spine bubble is getting ready to burst, so simple people like me can stop reading the self absorbed people like you!

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  101. A surgeon told me a few years ago, that a rep should not make more than $60k.

    I wanted to say, "Good luck with that buddy. I can find easier ways to make $60k".

    He is now involved with one of these grey area deals we are discussing. Still like the guy though.

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  102. PODs in the U.S. must not be very big or growing because all I read is a bunch of ortho/spine babble. Nobody has stated any facts about where they are located except for Texas and Alabama or how much money they are making. Lets get some fact on the table or lets move to a different topic.

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  103. Oklahoma City and Tulsa are RIDDLED with them.... If their is a physician owned facility near, you can bet a POD is there or coming soon.

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  104. which spine company has the most potential, and why would some spine companys not show up to the aaos this year.

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  105. 6:11
    At least you stated it correctly that the rep earned his money. But you obviously are one of those docs that would change companies if you thought the rep made too much money. You're just too damned stupid to realize that some lesser rep with a lesser product would be making the same amount on your cases (maybe more) so you would just be punishing yourself because you think you can control what someone else makes. Understand this: YOU DON'T GET TO DECIDE HOW MUCH A REP MAKES. YOU ONLY GET TO DECIDE WHETHER OR NOT TO USE HIS PRODUCTS. How much he makes is based on market demand for his ability to get your sorry ass to call him for your cases. Why do surgeons think they can decide what a rep, a CEO or a nurse should make? I don't get that mentality. Actually I do, it is the combination of pure ego and the complete lack of understanding of how the business world works.

    Be careful 6:11, my experience tells me guys like you that are too damned interested in what reps make are the ones who try to get your share of it thru lunches, gifts, wine, golf, trips, etc. Sound familiar doc?

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  106. Every dollar that anyone makes in this field, be it in commissions, fees for service, consulting agreements, speaker fees, free dinners, royalties, stock options, or whatever other creative boondoggle, comes out of the pocket of the people paying for health insurance, and of the people paying taxes. That includes us. WE OWE THEM A GOOD PRODUCT DOR A REASONABLE PRICE. In spine, that's utopia.

    On another note, when I buy a new car and it breaks down after 500 miles, I get a free repair, if not a new one. If I get a spinal fusion, and after 3 months my symptoms are worse than before, I'm asked to undergo another surgery at a higher cost than the primary one, because a revision is so much more difficult. And if after 3 months my symptoms are worse...... You get the picture. But Mr. Makker and many of his colleagues don't, they just get the money.

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  107. 6:11, your reps makes between 250 and 500? Wow, that's a pretty big gap...I'd be willing to be that 90% of device reps in this economy make less than 250k.

    I will agree with you that most people can do this job. What you should know is that very few enjoy putting up with so many "god factor" surgeons like yourself...it's tiring and at times I think the mafia has stronger ethics than the surgeons I encounter on a weekly basis

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  108. Ive seen surgeons(a few not all) do things to patients that would make anyone who knew better cringe. And it was strictly in the interest of jacking up their reimbursement. Ive had to leave the room a few times, when I just couldnt stand to watch any longer. Criminal. The stuff that 60 minutes horror stories are made of. Im sure im not alone in this.
    But what could i do as a rep? Say something? Lose my job while the butcher continues to rake in the cash at the expense of the poor people referred to them because "they are the best".

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  109. Guys, can we stop insulting our customers here. I doubt that is good for either side - doctors or reps - in the long run. We are both getting squeezed by payers and hospitals who welcome the day we turn on each other.

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  110. I am a spine surgeon in MD and I know the DePuy organization referenced above very well. I choose to use their products because DePuy has good products, but what really sets them apart in my geography is the outstanding service their reps provide. I don't receive any consulting fees from DePuy, but ignorant reps - such as the one above - probably use that as an excuse for why I don't select their product.

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  111. Hey 8:13 - nope, I don't think any of us (except maybe TSB through some tracking thing) know who the other posters are, unless they say something to identify themselves. That's what makes this blog cool. We are finding out that so many of us think the same way on many issues, while disagreeing and even being polarized on some. If we all sound like a broken record, it's because we seem to think alike. And yet, I'm pretty sure that I've never met or interacted with most of the folks on here, but probably do know some and might be surprised to know who is behind the perspective shared. As for not wanting to read comments from "self absorbed people" like us, then don't. My guess is that you gain the same value out of this that we all do, listening to or having a semi-intelligent discussion on topics near and dear to us. So that's why you (and we) will keep tuning in.

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  112. Dear Dr. 8:42 from MD. Do you recognize yourself, or any of your colleagues, in the 6:58 post?

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  113. At the meeting in Denver, just went by the Xspine booth! The person that posted the comments about VP of sales was dead on! Funny thing is talked to people about axel quoted 3 diferent commission amounts inlast 2 days 30-45%, maybe the botox and or lazerpeals have got to them. Who the hell is the old fat guy that has hair the color of ronald mcdonalds? WTF has hapened to this industry?

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  114. Wasn't that Carrot Tops older brother, aka Merrill Stromer?

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  115. I am glad surgeons like dealing with this company because they give such "great" service and are so ethical.

    Johnson & Johnson Settles Bribery Complaint for $70 Million in Fines

    WASHINGTON — A wide-ranging government investigation of corrupt overseas marketing practices by drug and device makers scored its first major victory Friday when Johnson & Johnson admitted bribing European doctors and agreed to pay $70 million in civil and criminal fines.

    Officials at the Securities and Exchange Commission said that Johnson & Johnson’s bribes might have harmed public health in several European countries. For years, the company tried to hide its illegal activities by “using sham contracts, off-shore companies and slush funds to cover its tracks,” said Robert Khuzami, director of the Securities and Exchange Commission’s division of enforcement.
    The case is the latest in a string of criminal investigations into illegal marketing practices by drug and device makers. Companies have repeatedly settled allegations that they paid kickbacks to doctors in the United States to induce them to prescribe drugs for, or implant medical devices in, patients who are unaware of their doctors’ financial incentives.
    With the settlement agreement from Johnson & Johnson, prosecutors have now begun penalizing companies in foreign bribery cases as well. Some top executives in the drug industry have suggested in recent months that the industry’s marketing practices may need to undergo wholesale changes.
    According to statements by the Justice Department and the Securities and Exchange Commission, the payments violated the Foreign Corrupt Practices Act, which outlaws bribes paid to foreign government officials, because doctors in many other countries are government employees.
    For Johnson & Johnson, the settlement comes at a difficult time. The company has issued more than 50 product recalls since the start of last year involving such household brands as Tylenol, Motrin, Rolaids and Benadryl. Last year, it recalled two popular hip implants that a recent study suggested might fail soon after surgery in close to half of the patients who received them.
    Mr. Weldon has denied that the company’s many missteps suggest broader problems in management or in the company’s structure as a set of loosely affiliated subsidiaries.
    Also on Friday, Johnson & Johnson agreed to pay $7.9 million to settle bribery allegations with the United Kingdom Serious Fraud Office. And it admitted as part of its deferred prosecution agreement with the United States government to having paid kickbacks to the Iraqi regime of Saddam Hussein under a United Nations oil-for-food program that investigations have since found was rife with fraud.
    According to a criminal complaint here and a case summary in Britain, Johnson & Johnson undertook an elaborate scheme to pay about 20 percent of the price of the company’s devices to Greek surgeons.
    Such bribes were so routine in Greece, according to the document, that an accountant for the company’s Greek sales agent had trouble understanding why he had to disguise the purpose of the money in his statements to Johnson & Johnson.
    A December 2001 e-mail from a top Johnson & Johnson executive stated that he was “very disappointed to read in your proposal references” to bribes “which cannot be mentioned in written correspondence.” Executives debated how to bring its bribes into compliance with the law, with one executive writing, “when we abandon the consultancy, we might as well abandon the business.”
    The company also paid bribes to Polish doctors and administrators who served on hospital committees that made purchasing decisions for medical equipment. Some of the bribes included paying for travel arrangements for doctors to attend medical conferences, a common practice throughout the industry. The company also bribed doctors in Romania who prescribed the company’s drugs.

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  116. Hey Doc at 8:42,

    I'm glad to see a doc post on here and actually have something good to say about his reps. And you are exactly right that inferior reps will always blame losing business or unattainable business on consulting agreements and such. I wish all companies would post their physician relationships online so these loser reps would know if surgeon truly is on the dole or not. Unfortunately, doctors like yourself, who are probably in the majority, don't get much airtime on this blog. While there are some alarming trends and practices going on that are discussed here, there is probably a lot more bitching and moaning by lesser reps who can't get to a customer like you because they are lacking the skills needed to be successful. The entitlement class is working its way into this industry. Just today I heard a rep say that a surgeon "owed" him. What an arrogant little punk. As you can imagine, I'm taking his business as we speak.

    Kudos to you and thanks for reminding us that there are some good guys out there.

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  117. The only question I have is would you Mr. Surgeon do business with a place who stole, cheated, lied, and defrauded people? Would you go plumber, car salesman, or an company that had this reputation just because they gave "good service"? Yet you defend it here as an acceptable practice when dealing with them as they continue to get caught in bribery scandals, kickback scandals, etc. etc. PLEEEEAAASSSSE!!!!

    Here is the good service company's last scheme to get business. Coming to a hospital near you soon!!

    J&J agreed to pay $70m to settle charges brought by the Securities and Exchange Commission and Department of Justice (DoJ) in the US. In the UK it paid £5m in a civil recovery order brought by the Serious Fraud Office (SFO) and agreed by the High Court.

    The charges relate to alleged payment of bribes to doctors in Greece, Poland and Romania to encourage them to use J&J products. The SEC also alleged J&J bribed hospital administrators in Poland to award the company contracts.

    In Iraq J&J was accused of paying kickbacks to the Government to obtain 19 contracts under the UN oil for food programme

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  118. Look into Stab'l Spine, Embassey Spine, Dr. Lokesh Tantawaya in San Diego. Dr Ramin Raisadeh and his brother.

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  119. Look at DS Medical in Cape Girardeau, MO. Dr Fonn fiance/office manager rep who rents office space from clinic. All neck cases are 360s and lumbar/thoracic cases range from 3-9 levels, cross connector at every level and 4 ammedicrap cages, xspine plates and screws. DS Medical foryourspine.com

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  120. What's really just funny is that Huntsville Hospital in Huntsville, AL and Providence Hospital in Mobile, AL both condone PODs. Both hospitals paid beau coup fines in the Kyphon billing scandal.

    Some people never learn.

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  121. Dear Dr. 6:11, Dr. POD, however you choose to identify yourself - reading your smug depiction of what reps do for a living, I notice one thing is missing: indictable behavior. If I were to define your business practices, I would have a hard time finding un-indictable behavior. Given the recent attention your little cash cow has been getting, how are you feeling now? A little discomfort? I suspect you'll be looking for some assurance from the law firm of Dewey, Cheetam and howe in the not too distant future. I hear the top bunk is the better of the two.

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  122. Ok, I just scrolled thru some of the post, and I did not study each offering. Having said that, running the economics of the medical device world has been done since day number one. While I do believe that companies strive to advance patient care, the objective is all about the Benjamins. I do work successfully in spine in spite of MDT's rebates, single vendor accts, consulting agreements, etc, etc, etc, that strongly influence surgeon selection. What really cracks me up is to hear the reps scream (or whine) about the unfairness pod's place in the market. Really guys. . . ? Remember you set the bar . . . Welcome to our world.

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  123. Is there a way to research whether your surgeon is part of a POD? Where can this research be done?

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