No fellow bloggers, TSB is not singling out Paradigm Spine, TSB is talking about the ongoing metamorphosis of selling medical devices in the good ol' U.S. of A healthcare system. Upon reading the pro's and con's in response to POD's, again, TSB believes that the investigation into POD's by the OIG and the U.S. Senate's eventual ruling will determine the future of all U.S. spine companies business model. As someone so aptly described, the focus on this topic has made us look foolish and divided. That's what usually happens when things begin to spin out of control. It is apparent that there has been a paradigm shift in what has been describe as our industry's revenue model. Questions abound regarding the longevity of what was, and what could truly be the future. If one believes in unfettered markets, well look no further, the spine industry is the perfect model. No rules or boundaries, minimize regulations, avoid accountability, erode science while emphasizing marketing. Hocus Pocus, we have resurrected our own three witches. Some of you will agree, while others will dissent, while some of you cry out to PLEAAAASE STOP THE INSANITY!
So what lies in store for the industry? How do we compete in an environment where the system is gamed, by our customers, and, our own peers? Will the strongest survive, while the weak perish? Has competition and free markets as once defined in America reared its ugly head? As Linda Richmond use to say, "can we talk, gather around." While we debate whether POD's are legal or illegal, surgeons attempt to paint themselves as altruistic by claiming that there only concern is to save the hospital money as the industry's "new gatekeepers," Rome burns. If profits are not the motivation behind their actions, then what is? The love of medicine, LOL!
But what about hospitals? What about these bastions of modern day healthcare? Have they helped the current environment, or, are they the culprits behind perpetuating this chaos? Explain the rationale for taking away a surgeon's ability to use whatever product he or she desire, if we truly believe in free markets? Isn't the surgeon the one that has spent endless hours and hundreds of thousands of dollars to be the gatekeeper? As hospitals BS surgeons that they must work together, they manipulate the environment to only benefit themselves. If the hospital is footing the bill for implants, isn't it their responsibility to negotiate a fair and equitable price, and not the surgeons? Or is this just another ploy to keep the surgeon's focus off of the eye of the tiger. Slowly but surely, they are becoming the hospitals slave. As Michael Corleone once said, "every time I try to get out, they pull me back in." How many times have you sat across from a hospital administrator that has informed you that regardless what Dr. Famous would like to use, you are not a preferred vendor? WTF does that mean? TSB wants to know what MBA, CPA, JD, or MD came up with that BS description? How many times have you been told that in order to get your product into the facility, you will have to meet with the Product Evaluation Committee (PEC), only to find out that the next meeting will take place in four weeks, if you are lucky? How about the facility that informs you that you will have to wait until the end of the year to submit an application for preferred vendor status. WTF is that all about? If there is one thing that we have learned is that PEC's only exist to stonewall a potential vendor from getting into the facility. What happens if you really had something that was truly innovative or clinically advantageous to the patient's care, would any of us want to wait if it was our health at question? What happens if you can offer comparable technology with added cost savings to the facility? If price containment is the impetus behind POD's, and surgeons are willing to use a product that saves the hospital money, does it really matter what product one uses, as long as they are comparable? How many times have we heard that a screw is a screw, a cervical plate is a cervical plate, etc., etc., and so on? A bit of a paradox. The apathy that exists at hospitals is a study unto itself. Can anyone make a simple decision? Brain surgery isn't this complex. Are we experiencing the death of common sense?
As hospitals squeeze us on pricing, they continue to reap the benefits. Ever sell a pedicle screw for $800 dollars, only to find out that the hospital billed the carrier $ 8,000 per screw. What other industry can do that? Ever sell BMP for $5,000 -7,500 only to find out that the facility billed the carrier $22,000 and an additional $8,000 for some TCP sponge? Let's face facts, medicine is no longer based on care, it is based on profits. And that my friends is why whether one believes it or not, or agrees with it or not, the system will eventually evolve into a one payor system. The current system cannot sustain itself, and the faster we come to grips with reality, the faster we can move on. It won't be called socialism, it won't be Obamacare, it will be called survival. As healthcare delivery consumes 25% of the GDP, does anyone truly believe that it happened in the last two years? As Arnold use to say, "listen to me now, or hear me lader."
Global consolidation has changed the rules of engagement. Commentators that have eulogized those bloggers that have objected to POD's are only adding fuel to the Senate inquiry or an OIG investigation into the legality of this model. Exhibiting one's hubris has been known to come back and bite you in the ass, if you don't believe it, ask Anthony Weiner. So in closing, what will the new model evolve into? Will forecasts be realigned to meet the markets structure, or will we continue to live in the past? How does one continue to grow in a stagflated market? As a commentator to our blog love's to espouse, "you sales people are living in the past," maybe, that individual is only half right. Maybe its the executive management teams at these companies that are living in the past, creating the illusion that all one has to do is keep the status quo and things will be alright. But then again, maybe its the same people that have created this monster, that are now attempting to figure out how to survive. Two years, three years and its on to the next scam. You can throw all the marketing studies and procedural databases out the window, there's a new paradigm shift in selling, and if don't believe it, you won't survive.
First I was afraid I was petrified, thinking I could never live without you by my side
But I spent so many nights thinking how you did me wrong, I grew strong, I learned how to carry on
And so you're back from outer space, I just walked in to find you here, with that sad look on your face
I should have changed that stupid lock, I should have made you leave your key
If I'd known for just one second that you would be back to bother me...... I will survive.