Monday, October 17, 2011

The Silly Season

Fellow bloggers, as the last vestiges of summer leave us, and we enter the spine silly season, CNS, NASS and of course the Spine Technology Awards, TSB must ask the $10 billion dollar question, where is the innovation and emerging technologies that we have been waiting for?  Our correspondents that attended CNS and roamed the conference room, excuse us they meant, the exhibit hall in Washington, DC, reported that CNS must be concerned with the legitimacy of a meeting whereby attendance may have been at an all time low.  With the exception of K2M, which launched some new cervical products, was there anything that truly was a game changer?  The perception was that some companies hardly had any traffic.  As usual, CNS strategically placed the "big boys" in the center of the exhibit hall where they erected their temples (small one's at least) so neurosurgeons would pay homage to them as they walked to the back to listen to the speakers and papers that were presented.


Interestingly, NuVasive, aka the Billion Dollar Baby, was missing from the festivities.  Could they have been licking their wounds, or, was NuVasive one of the smarter companies not wasting their time and money considering that NASS is right around the corner?  So what is truly happening in spine?  Have we "out innovative" ourselves?  The Spine Technology Awards will be a barometer of where the industry is truly headed.  Who will present in the various categories for OTW?  Will the judges be comprised of the "usual suspects?" Will there be anything different, or, will this be another humdrum performance?   Every now and then our readers provide us with their words of wisdom regarding the state of the industry, but how does one keep their motivation and eye on the ball when some of the companies that you work for have done NADA to create that 6 degrees of separation for you to continue to grow your business and meet sales expectations?  So here is your opportunity for your voice to be heard.  What is it that your company is launching or selling that will provide you with the necessary ammunition to take out the competition?  If anyone knows what's going down, it is always those in the infantry, regardless whether the generals admit it.  Is spine the last frontier for medical devices, and has time caught up with this well insulated industry.  As hospitals continue to drive down pricing, and insurance companies deny procedures, how is this affecting your ability to grow?

It will be interesting regardless whether Obama gets re-elected or not, because as more companies focus  their efforts into foreign markets, they are behaving like the rest of America's titans of industry seeking new markets. The backlash from all of this will be more and more foreign made implants glutting the U.S. market, driving down the actual selling price.  So TSB wants to know where is the technology and does your company have it?

114 comments:

  1. TSB,, Not sure who your sources might be, but Nuvasive pulled out of CNS several years ago. Not being there this year had nothing to do w/ their recent issues.

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  2. Baxano's booth, albeit small, seemed to be pretty busy the few times that I walked past it. I heard several surgeons talking about
    iO-Flex saying that they thought the concept certainly made a lot of sense.

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  3. Excerpts from a recent Nuvasive Sr. Mgmt. team mtg. in San Diego:

    Valentine: Christ. Nine years of hard work down the drain. Might as well join the f-ing Peace Corps.

    Rydin: War's over, man. Medtronic dropped the big one.

    Lukianov: What? Over? Did you say "over"? Nothing is over until we decide it is! Was it over when we had our allograft recall? Hell no!

    Miles: Allograft?

    Valentine: Forget it, he's rolling.

    Lukianov: And it ain't over now. 'Cause when the going gets tough,, the Cheetahs get going!! Who's with me? Whos' in? Everyone, send your email responses!! Let's Go! Come on! AAAAEEEEEGGGHHHH!! [Alex runs out of the room alone; then returns] What the hell happened to the Cheetah Nation I used to know? Where's the spirit? Where's the guts, huh? "Ooh, we're afraid to go with you Alex, we might get in more trouble, the stock price might drop more" Well just kiss my ass from now on! Not me! I'm not gonna take this. Medtronic, they're dead! Neurovision (the company), dead! Michelson, dead...

    Miles: Dead!! Alex is right. Psychotic, but absolutely right. We gotta take these bastards. Now we could do it with conventional implants, but that could take years & cost millions of lives. No, I think we have to go all out. I think that this situation absolutely requires a really futile and stupid gesture be done on somebody's part.

    Lukianov: We're just the guys to do it!!

    Rydin: Let's do it!

    Lukianov: LET'S DO IT!!

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  4. @ 230pm That is absolutely the funniest thing I have read in a long time. Nice job!!!

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  5. Hey, maybe alphatec will announce GLIF at NASS....again.

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  6. I heard Globus may actually announce its intention to go public during NASS.

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  7. Globus ain't goin public anytime soon...with them getting sued left and right and nothin absolutely nothin new in the pipeline that dream would remain a dream for quite some time

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  8. This will be the shortest blog ever.... No one will have any new exciting technology to post.

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  9. What about the FLEXOL device by S-TEC? Seems pretty innovative to me!

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  10. K2M's new cervical products? Surely you hopefully are referring to another product besides their translational cervical plate. That is nothing special.

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  11. Im glad you all could show up tonight, I would like to talk to you about our feature product, term life insurance...................

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  12. NUVA is about to release a new expandable cervical corpectomy cage.
    Much like their X-core. Very slick.

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  13. Can Nuva ever recover from losing Dr. Cappuccino?

    Av's in first place, Broncos in last, Lanx makes the trade of the season.

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  14. The new normal
    http://finance.yahoo.com/news/Analysis-As-patients-put-up-rb-278688748.html?x=0&.v=1

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  15. How about TranS1 finally making it? New implants, another round of financing, a PEEK dialator lateral system....

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  16. Stryker released and is now educating on powered screw insertion. With their market share in power drills, this is interesting. I think medtronic is close to having this too.

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  17. To 7:52
    You sound very bitter, how can you say there is nothing in their pipeline.?
    How can you say they will not go public soon?
    I have no skin in this game but will applaud the globus "when will they go public" blogger on the day they ring the bell in NY

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  18. Medical Device Makers Face More Pricing Pressure

    By Anjali Athavaley and Jon Kamp
    Of DOW JONES NEWSWIRES

    NEW YORK (Dow Jones)--U.S. medical-device makers are facing ever more pressure on product prices and profits, a new report suggests, because their hospital customers are getting squeezed by high product costs and are looking for relief.

    Hospitals lost more than $1 billion on procedures involving expensive medical devices and would consider buying lower-cost alternatives, according to the report from hospital-owned purchasing organization Premier Inc. Its surveys of hundreds of hospitals and health officials underscore a key challenge for device makers like Medtronic Inc. (MDT) and Boston Scientific Corp. (BSX), which are also grappling with slowdowns in some markets brought on by economic turmoil.

    "Hospitals are going to have to get very diligent in being able to provide high levels of care but in a very cost-effective manner," said Mike Alkire, chief operating officer at Charlotte, N.C.-based Premier. The nation's second-largest group-purchasing organization, or GPO, serves more than 2,500 hospitals.

    The device industry indicated this is something it's accustomed to managing. "We are not strangers to price pressures," said David Nexon, senior executive vice president for the Advanced Medical Technology Association, a trade group representing device companies. "The bargaining is pretty vigorous right now."

    Hospitals come under pressure as device manufacturers seek higher prices for new pacemakers, replacement knees and other products. One Premier study of 323 hospitals identified $1.82 billion in hospital losses last year resulting from shortfalls in Medicare reimbursement for 12 types of heart and orthopedic procedures using implantable devices. The losses were highest for heart valve replacements and spinal-fusion procedures.

    Additionally, a separate Premier survey of 740 hospital executives and supply chain directors showed that about 70% would try lower-cost alternatives that demonstrated the same or better clinical outcomes to brand-name products they use in areas like trauma, which involves plates and screws used to repair broken bones.

    The report highlights why device makers are already seeing push-back on prices for some products. It's not a new trend, but it's one that could worsen amid the looming threat of potential Medicare cuts as lawmakers wrangle over deficit cutting. While device makers selling pricey cardiology and orthopedics parts have long relied on strong relationships with surgeons to support sales, hospitals are gaining more control of purchasing decisions by buying out physician practices.

    Premier's report highlights accelerating pricing headwinds for device companies, according to Goldman Sachs analyst David Roman. Goldman is "incrementally more cautious" on the medical devices industry and its growth potential next year, Roman said in a research note.

    Cost-cutting at hospitals may hurt some companies more than others. Companies like Baxter International Inc. (BAX), C.R. Bard Inc. (BCR) and Covidien PLC (COV) that make lower-cost medical supplies are more insulated than companies making high-priced implants like Boston Scientific, Medtronic and Zimmer Holdings Inc. (ZMH), said Michael Matson, an analyst at Mizuho Securities, in a note.

    "The hospitals appear very focused on reducing the costs of ortho and cardio implants, but it was noted that more commoditized products are now at more reasonable levels," he said.

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  19. 10:14 Time out... Back up the truck. nuva lost cappucino??? that is big news, can you expand on that. would be like msd losing foley.

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  20. ^ yes please elaborate

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  21. In response to 10:14,

    For those at Nuvasive, here is the Heritage Dictionary definiton of "karma": The total effect of a person's actions and conduct during the successive phases of the person's existence, regarded as determining the person's destiny.

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  22. Everyone post the new and innovative offerings of your respective spine companies (Pictures and surgical techniques if applicable). Globus engineers, grab your notebooks and send your retainer checks, it's time for a "new" product!!

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  23. This is great! HAHAHAHA

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  24. Cappucino link...

    http://www.marketwatch.com/story/lanx-inc-announces-formation-of-surgeon-advisory-board-2011-10-17

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  25. Trans1 received subpoena from the OIG last night. Stocks down big. Talk about a trans-rectal approach...

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  26. So, with the FDA pushing their agenda, payers looking for outcomes to give the thumbs up to pay for new innovation, device companies are going to have to re-tool their development process vs. the current Xerox strategies or product improvement as it's high cost for low return. Most, and it would be easy to say all have never really had to prove their device, system etc. actually improves patient outcomes. That's why MIS is in the pooper, dynamic stabilization is on terminal hold and TDR going no where fast. Biologics have promise, particularly stem cells, but not the minimally altered stuff as it too will have to show something real past fusion statistics since fusion and outcomes do not walk hand in hand.

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  27. My company didn't show anything new at CNS. They did however unveil their new comp plan to the feet on the street:

    1st prize is a Cadillac Eldorado
    2nd prize. Any body want to see 2nd prize? 2nd prize is a set of steak knives.
    3rd prize...

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  28. Great line from a funny movie. My a-hole mgr at MDT Neuro use to use that line at our sales meetings. Pretty accurate representationt of MDT compensation. Worst in the industry. Criminal.

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  29. you are all so stupid...so stupid and ignorant.

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  30. Enlighten us Einstein.

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  31. Your name is "you're wanting", and you can't play the man's game, you can't close them, and then tell your wife your troubles. 'Cause only one thing counts in this world: get them to sign on the line which is dotted. You hear me you faggots?

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  32. I immediately regret my post on TranS1. This could be the final nail in the coffin. With a sales force down to about 20 people, decline of 26% in sales vs 2010 and now the subpoena, they are as good as dead. I thought there might be a chance for a rock bottom priced sale, but this will stop that from happening.

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  33. And TranS1 raised $18.3M just 3 weeks ago with an additional public offering at $3.25/share. I bet the lawyers have already started writing the suits on the investor's behalf now that the shares are under $2.00. I'm guessing the DOJ and lawyers will take most of the $18.3M leaving TranS1 and their investors with nothing.

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  34. 1:29 & 2:58

    "Lighten up, Francis!"

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  35. Anyone know what in particular TSON is accused of in that suit? All the press releases state is "fraud".

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  36. There are so few new products because the companies are all afraid to invest R&D $ into an environment of uncertain reimbursement.

    Wait until Obamacare kicks in fully to see how quickly government policies can kill product development. If it's not killed by the Supreme Court or repealed by our new president in 2012, we will all be wandering around CNS in 2016 asking each other if we can remember the last product launch that wasn't a cervical plate set with new handle colors...

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  37. How bad must it be at Nuvasive when one of the founders/ developers of a product like PCM leaves the company that purchased the device that he helped design? The downfall continues,

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  38. I bet that the fraud is over how most of the AxiaLIF procedures are billed, with CPT code for ALIF and not using their designated T-Code 0195T. Turns out that the ALIF codes pays and the T-Code rarely gets approved and if it does, doesn't pay. I wonder how many of their 10K + procedures were with each code. My bet is that at least 75% were ALIF.

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  39. Spine is dead...pricing is dead, technology is dead. Hospitals are looking to cut costs and the first place they look is spine/ortho. Everything has been commoditized by these #$@!&^@* consulting companies that have no idea what we do on a day to day basis, but think they have the power to show up and take $$ out of our pockets. Ive been doing this 8 years...its as bad as ive seen it. Bad bad scene

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  40. i read this blog as often as possible and don't typically comment on many things, but this is one i feel i can shed some light on. please all you critics out there don't get all defensive just stating an opinion. i been doing this for almost 10 years, just giving you my out look.

    on the topic of new technologies, i think we have seen the end for a long time. there may be some innovations to procedures we are doing now, but if you waiting for the next impactful products such as the "XLIF" or "standalone cages" your going to be waiting till your old and gray. With the new device tax soon to take place by the US Government companies are going to have to find a place to pull this money. My guess it will come from R and D. with that being said, if some of you ship jumpers are looking for the next best thing. probably not gonna happen.

    People need to start realizing this industry has changed and my advice is this. there are 3 key aspects to this business.

    1.price- anyone with a half a brain knows that us as reps/Managers have zero control of this. lets face it, they are gonna pay what they feel like paying. the days of $500 screws across the board are closer then you think. Bottom line price is out of control so don't stress about it!

    2.Technology-well i addressed this earlier, i think we've seen the last for a while but we shall see. i could be wrong. Again though us as a rep/manager have zero control of this. my advice don't stress about it! its out of your control.

    3.Service-well this is the one we can control. this is the one that can make us an asset to a client. this is the one where a surgeon and hospital can see our value. stop with the half ass trays, not enough implants, wrong trays, etc.....no names medtronic. Get there early and be the last to leave! help out central, put trays back together for your techs!

    Im not gonna preach how to be perfect cause i don't claim to be. but take control of what you can control and those things out side of you control let the guys in the suits behind desks figure out.

    Good Rep+Great Service=quota! simple formula.

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  41. 746

    Very good point about the scum of "pricing cosultants" making the rounds at hospitals. This is nothing more than price fixing by hospitals within a region. Competing hospital execs are not allowed to sit at the same table and fix prices, but these turds are allowed to visit each hospital in town with a wink and a nod tell what everyone else is paying.

    Sure enough after one of these guys gos through town, every hospital is paying the same (crappy) pricing. Of course they put a percentage of the proceeds from their illegal activities in their pocket. This sort of price fixing by hospitals has taken more money out of our pockets than any other factor going on in the industry- but no one seems to talk about it.

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  42. 815. Nice and insightful post but the service aspect is losing it's value in the eyes of my customers. It's still matters but not like it use to. Im a 10 year plus vet as well. I had had docs tell me the the service I bring is second to none but they have other priorities (agreements, family member reps etc). Since they still respect me as a rep, they still give me 10% of their business. The hospitals could care less now adays. They care about 2 things. What the surgeons want and pricing. Not so simple to make quota if your quota increases 3% per year but pricing is dropping 20% per year and procedure volume is decreasing due to insurance companies slow to approve fusions. A lot of factors make it very difficult to succeeded in today's environment. Though your right, just have to worry about what you can control which has been significantly reduced. The good days are behind us unfortunately.

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  43. Another outcome will be that reps will leave if they are not getting paid. This will reduce competition thru rep attrition. New opportunities will arise. Position yourself as a good #2 with excellent service and you will gain business. Focus on new/younger surgeons too. It will take time but the business will come.

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  44. 5:08 am.... Why exactly is the idea of determining fair market price such a bad thing? I understand that means you can't screw 'em on the pricing (& justify your high salary), but don't your supply chain managers attempt to determine the best price when it comes to your business purchasing goods?

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  45. So....pricing is dropping across the board. Two questions:

    1. What is the bottom? Say on a pedicle screw? and
    2. What event(s) would have to occur to allow a company increase prices in the spinal fusion market? A new product? A new procedure? A new study? Something else?

    Thoughts anyone?

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  46. 7:18

    Look up antitrust law and horizontal price fixing. There is a big difference between shopping for the best price (totally legal)and price fixing where all the buyers in a market together to agree on what they will pay (antitrust violation). That's not a fair market activity, and it's illegal. Using these "consultants" as middlemen to collude between buyers doesn't make it okay. These hospitals are deep in the gray area and they know it.

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  47. I am the owner of a small Med Device Mfg Co. on the east coast. I make parts (screws, cages, peek spacers, plates, ect...) for a few of the companies you guys regularly bash!

    If you guys are saying that the good days of spine are over, where should I point my sales force? Spine has been doing us well for 5-6 years now, but I would hate to keep growing a company all in this one market. Especially if I am getting in on the down side. I have watched as some local shops went from 2-3mil to 10-12mil, then get bought up. That's not what I'm looking for, I'm in it for the long haul!

    Where should I go?

    Oh, the price fixing will take a BIG bite out of the Mfg's asses out there cranking out all these parts too. Even tho I make $200 on a Ti/Peek cage, and they sell for what? 2-3000?

    Anyone need a new CNC Machining/Device Vendor??

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  48. Heard Orthofix is going to be "best in class" for spine in the next year or so...thoughts??

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  49. this thread is sad

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  50. 9:39 - keep making spine parts. Your profits will be fine, the spine companies will squeeze their distributors harder than you (they've been comparison shopping prices from your competitors all along...they konw there's not much juice to squeeze out of you guys) but beware of some of the smaller companies having trouble paying their bills. I've heard some horror stories about some big orders to machining suppliers going unpaid recently. It's come up too often in the last 2-3 months to be a coincidence.

    I suspect there will be a wave of bankruptcies among the smaller, weaker spine companies in the next year.

    pick your customers carefully! I wouldn't want to get stuck with those kinds of unpaid receivables.

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  51. Did Cappuccino completely leave Nuvasive? Based on that link, just looks to be on some advisory board for a smaller company, Lanx. Does Lanx even have a lateral system? They are not in my area, but don't know of any products outside of the Aspen plate

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  52. 9:39

    Nothing to worry about. Just deliver parts at a fair price on time and on tolerance every time. By doing so, you will put yourself in the top 5% of contract manufacturers in this industry and customers will beat a path to your door. Spine isn't going anywhere, and the quality players will do well.

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  53. Can we kill this thread and start another one on evil PODs and greedy doctors taking the food off of our tables selling dangerous, inferior implants at below market prices? Those seem to draw a lot more commentary.

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  54. 939- "I suspect there will be a wave of bankruptcies among the smaller, weaker spine companies in the next year."

    I hear this every single year, yet very few hopeless spine companies actually die an honest death. These zombie companies manage to hang on year after year. They have no new technology, no growth, but with the bought business of a handful of misguided docs, these living-dead companies can linger ghostlike among the living seemingly forever.

    They may even have nice booths at NASS, well-dressed minions, and a few shiny products, but the carcass is very slowly rotting underneath...

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  55. 09:39 - keen to chat to you in private regarding how I may be able to help.

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  56. As far as Trans1 goes. It's not fraud for a surgeon to choose to code an AxiaLIF as an ALIF. It's the surgeons choice. Now if there is some sort of proof that T1 reps are pushing doctors to use the ALIF ocde instead of T-code, then that's a different story. AxiaLIF is Anterior column support. It can be coded as an ALIF if the surgeon so chooses.

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  57. 2:00...
    Keep telling yourself that your competition is going out of business while the "ankle bitters" are taking what business you have left and are laughing their way to the bank! You are probably the same anonymous poster that says PODS are illegal and anything else you can sale yourself on as to why your former surgeons have left your company because of your boring corporate consulting agreement. Can you truthfully name any of these companies that you want to hope are future carcasses? Please, if you and your product are Best in Class then let the better man (woman) Win!

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  58. 3:02: Trans1 reps have been telling docs forever that the ALIF code is ok. "its an anterior lumbar interbody fusion, right". Then they compare it to XLIF using the ALIF arthrodesis code. LOL. Talk about apples vs. oranges

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  59. There is no reason to compare it to XLIF. It just simply is an anterior fusion. And again, its about the proof that surgeons have been directed to use the ALIF code over the T-code.

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  60. If you want to see an innovative spine technology, watch the "Science on the Street" segment about the new SentioMMG Nerve Mapping Tool, to air 10 am Friday morning 10/21 on CNBC.

    http://www.fiercemedicaldevices.com/special-reports/5-devicediagnostic-companies-watch?grover_pusher_fmd

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  61. The T code is a directive by CMS. You can't get away with coding Asslif as an ALIF when there is a specific code for it. Yes, I'm sure there is plenty of proof that they told their reps to convince surgeons to code as an ALIF. The greed for revenue has finally caught up with them. Upper management is very unethical.

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  62. TranS1 should get bitch slapped by OIG. You can draw a straight line to little(short, tiny, small minded) Ricky Simmions. Good job Rick. The only probelm is he was fired before all this caught up with the company.

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  63. @2:31 - I am temporarily forfeiting my anonymous status for the moment....

    mklesh@mkprecision.com !

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  64. I am a neurosurgeon and have used the AxiaLIF device. I guess I was lucky because I did use the T-code and was reimbursed after sending in three additional letters to the insurer. Their rep did not tell me to code the procedure as an ALIF, rather he did not discuss coding at all.

    However, if TSON is being accused of fraud by the OIG, then the OIG also needs to look into the companies selling these dowels for facet fusion. I have used two of those products in the past, Nufix and Verteloc, and each of their respective reps told me specifically to code the procedure as a posteriolateral fusion (22612) and not to use the T-code (0219T). I chose to use the T-code and have still not been reimbursed on those procedures to date. Coding guidelines state that the 0219T code cannot be listed at the same level as the fusion (22612), but that's not what they were conveying to me.

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  65. Was I the only one to actually read the link about Trans1? The investigation is for violations of the Foreign Corrupt Practices Act which is the bribing of foreign officials. It has nothing to do with coding or billing or anything like that.

    I'm not defending them, I think the procedure is absurd, but let's at least discuss the real story.

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  66. Hey Doc.

    Just a heads up! Rule number 1 never take billing advice from
    a Rep who works for a half ass company. You don't gotta be a brain surgeon to figure that out!! (Pun very intended) haha!

    Sincerely,

    Long standing successful rep who knows better then to ever give billing advice. They have billing services these days! Give your doc a phone number stop trying to be a hero!!!

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  67. 7:09

    I am laughing! 5:55 should have done the research on those two facet fusion companies before he even used their products. In my opinion, to say that they are half-ass would be a compliment. No-ass is more like it!

    FYI - just heard that the Minsurg (Trufuse) lawsuit against all those other companies has been settled. I also heard that Minsurg is out of business. Can anyone shed any light on this to be fact or fiction? I hope it's fact because facet fusion dowels don't work.

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  68. 7:07

    I haven't seen anything, anywhere referring to an FCPA investigation. Can you please point to a link where you saw this?

    Thanks

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  69. Anyone heading to the SMISS mtg. this week in Vegas? Awesome, I'll see you there.

    Regards,
    Anonymous

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  70. I would love to see data on how many surgeons code for 22845 in addition to 22851 with zero profile devices that are not a plate by any stretch of the imagination. I know of one company that actually had it in writing that you can code for a plate.

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  71. I heard that Trans1 will be offering a coding session for the product(s) at the Spearmint Rhino is Vegas?

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  72. NASS guidelines state that if the facet joints are prepared and stabilized, then it is proper to code for a posterior fusion. Thus it must be specifically recorded in the op note...likewise that is why when I use an interspinous fusion device ie Aspen or SP-Fix, I include the facet prep so as to be proper in coding.

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  73. Feds subpoena TranS1 in fraud probe
    October 18, 2011 by MassDevice staff

    The federal Dept. of Health & Human Services issues a subpoena to TranS1 Inc., seeking documents in its probe of alleged health care fraud and false claims by the spine surgery firm.


    The U.S. Dept. of Health & Human Services sent a subpoena to TranS1 Inc. (NSDQ:TSON) seeking documents for its probe into the spine surgery firm.

    The Wilmington, N.C.-based company revealed the Oct. 6 subpoena in a regulatory filing yesterday.

    "The subpoena seeks documents for the period January 1, 2008, through October 6, 2011," according to the filing. "The company is cooperating with the government’s request and is in the process of responding to the subpoena. The company is unable to predict what action, if any, might be taken in the future by the Department of Health and Human Services, Office of Inspector General or other governmental authorities as a result of the matters related to this subpoena or what impact, if any, the outcome of these matters might have on its consolidated financial position, results of operations, or cash flows. No claims have been made against the company at this time."

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  74. Sounds like somebody at OIG is unhappy about AssLIF coded as ALIF!

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  75. 8:01

    The investigation of Trans1 is for fraud/false claims, not necessarily foreign corrupt practices. So anything is on the table, including coding/etc.

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  76. At Eurospine now. Very busy here with a lot of Surgeon and staff attendees and many new products. Perhaps too many new products but that is healthier than none.

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  77. We can all agree that innovation in the US is gone . If you think it's bad now wait till 2013 when the device tax hits. The ankle biters will be gone in 2013 due to the Device Tax. No way to survive after this. Wanted to thank all you selective morons that post idiotic comment on this blog. It's the only reason I read it. Gets me up in the morning knowing your my competition and I will continue to kick your a--.

    Best regards.

    The $20B tax was included in the Affordable Care Act that was signed into law in 2010. The amount is based on a 2.3% excise tax that will be levied on the total revenues of a company, regardless of whether a company generates a profit, starting in 2013. Many companies will owe more in taxes than they generate from their operations. The result will be devastating to innovation, patient care and job creation

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  78. 11:02
    NASS Guidelines may be wrong. Here is the verbatim AMA guidelines for intrafacet fusions.

    As far as coding goes, here's what the AMA states verbatim:

    O221T - Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; lumbar.

    Do not report 0219T-0221T in conjunction with any radiological service.

    Do not report 0219T-0221T in conjunction with 20930, 20931, 22600-22614, 22840, 22851 at same the level.

    I think thats pretty clear. Not sure where NASS got their guidelines, but NASS is largely irrelevant anyway.

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  79. 3:27 Thanks for the info. I wonder what TSB thinks about this, assuming his guy Obama had something to do with this Affordable Care Act.

    And NASS is relevant for the fact that they tell CMS how to do things. Better hope the leaders of NASS use your stuff.

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  80. The NASS leadership is bought and paid for by Medtronic and to a lesser extent the other big companies. Just look at their disclosure statements. The fact that they control the coding is a travesty. They will use this power to screw their competition and help their sugar daddies.

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  81. 11:02 - You must not be able to read.

    3:31 - You have the guidelines exactly right.

    The AMA clearly states that intrafacet implants (i.e., bone dowels) should not be coded at the same level as the fusion. So, in essence, if you prepare the facets and just stuff some autograft in them (in other words not use any form of allograft bone dowel), you can then code a 22612 with no problems. That has been done for years and nothing has changed.

    However, if you are placing an intrafacet implant (i.e., bone dowel) at the same level of the fusion, YOU MUST USE THE 0221T code. Thus, most likely you will not be reimbursed because of the T-code. In fact, several insurance companies in their policies specifically state the products Trufuse and Nufix. (Just do a Google search and you will see these policies.) But, just as a pedicle screw is a pedicle screw, an intrafacet bone dowel is an intrafacet bone dowel. It doesn't matter if it has ridges, grooves or spikes. The 0221T code applies to ALL bone dowel products regardless of the shape, size or company who sells them.

    When the OIG gets wind of this scam, there's going to be a lot more than bone dowels popping out here. And the companies, reps and distributors that have been telling us surgeons to code these procedures as posterolateral fusions are going to be in a lot of hot water.

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  82. There is a simple solution to bone dowel coding. Just throw some bone over the lamina in addition to the dowel. There you go posterolateral fusion. Don't even bill the dowel. Nuff said.

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  83. 7:22

    Your formula just drives up hospital costs and is not the solution here, but at least you got half the formula right. All you have to do is burr the facets, pack some local autograft from your laminectomy in them and not even use the $5,000 bone dowels. Then, the costs are lower and there are actual studies that show this method works. The solution to bone dowel coding is just not to use them in the first place.

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  84. Amedica just fired and cleaned house on the sales side.

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  85. Does Orthofix/Blackstone have its surgical technique for the 3D cervical plate posted online anywhere to download?

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  86. At 6:57 What I said in no way contradicts what you have accurately written re. using code 22612. I was simply clarifying facet preparation and grafting for proper use of the code. As I don't use the dowels it really doesn't matter much. Likewise the AMA guidelines are not static, nor are they black and white. Their interpretation changes like the wind.

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  87. Thank you all for the late night laugh... better than Letterman!

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  88. Has anyone seen a robotic pedicle screw case?

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  89. No, I have never seen R2D2 or C3PO ever do a pedicle screw case. Do you mean navigated?

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  90. Yes, I work for Mazor and we do plenty of deformity and degen cases. We have our own implants and screws coming out this in 2012.

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  91. The banter here reminds me often of these lines from Under Siege: LOL...this captures it well:)

    Casey Ryback: What made you flip like this?
    William Strannix: I got tired of coming up with last-minute desperate solutions to impossible problems created by other fucking people.
    Casey Ryback: All of your ridiculous pitiful antics aren't gonna change a thing. You and me, we're *puppets* in the same sick game. We serve the same master, and he's a lunatic and he's ungrateful. But there's nothing we can do about it. You and me, we're the same.
    William Strannix: Oh, no. No. No. No. There's a difference, my man. You have faith. I don't!
    [a knife fight erupts between them]

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  92. Your Turn "John"

    Seems like everyone has had they're turn at being written about "bashed" by the spineblogger and his followers. Everyone except Mr N himself. Well this week in the spine blogger has officially been "unmasked" by writter Walter Eisner in the latest copy of Orthopeadics This Week. John you have had some career in orthopedics and spine, nothing worth bragging about at all. But you did it. You made a name for yourself. You must be relieved to finally be outted so to speak. Perhaps all the people who have ever worked with John could share some onfo on what kind of persone he is. What kind of job did he do?? I'm sure there is much to learn and what better platform -

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  93. Dude, old news. The OTW article was from July. Some of us like TSB the way we all are, anonymous.

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  94. 12:52

    "What kind of job did he do??"
    Ans. Who cares because he's one hell of a blogger being TSB!

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  95. 12:52 you putz. Please use spell check.

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  96. 12:52 You are a tool. What makes you think you are correct in your statement. I have heard several names, one an individual out of Scottsdale

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  97. 12:52 jerks off in a closet with a belt around his neck wearing clown makeup, ballet shoes and a hitler mustach while screaming and force feeding himself litter box cat turds.

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  98. Scottsdale = ronaldmcdonaldclone@gmail.com, combmyearhair@gmail.com, or whengrecianformuladontworkusecoolaid.net

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  99. THE ONE COMPANY NOBODY SPEAKS OF, IS WHERE ALL MY MONEY IS, I THINK THIS IS A GOOD THING, COHIBAS FOR ALL!

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  100. Oh you mean Small Bone Innovation, must be a freudian slip.

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  101. What are your feelings on X-spine?

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  102. Orthopedics this week put a name on spine blogger
    "John Nieradka"

    who the hell is that???

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  103. Began my career at Synthes USA as an AO/ASIF Consultant. After a successful career in sales I was hired by Stryker/Osteonics as part of the management team at Stryker Trauma. Responsible for the initial concept of the T2 Antegrade/Retrograde Femoral and Tibial Nail. Segued into Business Development and Marketing at Surgical Dynamics and Blackstone Medical launching numerous spinal deformity systems. Worked as a consultant raising capital and negotiating licensing agreements between educational institutions and early growth stage companies. Spent one and half years at Custom Spine as VP of Sales and Marketing. Currently employed at Choice Spine in Business Development

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  104. so the spine blogger is John Nieradka???

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  105. The last four posts by the same person

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  106. If OTW said it, then it must be true lol

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  107. You are wrong it isn't john. I hope the true blogger sends your ip add. to john. It will be allright Stanaford

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  108. they didn't say it or just blurt is out. Orthopedics This Week wrote a complete article about it

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  109. Oh you mean the Orthopedics This Week who probably is attempting to figure out who TSB is because they are probably getting their asses kick subscription wise

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  110. Is Todd Stanaford still living in Midland Texas

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  111. BodyTom portable ct scanner. Bye bye oarm

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  112. Cappuccino is no longer using Nuvasive products. He is 100% Lanx. His Nuvasive rep has left Nuvasive and is starting a Lanx distributorship. Cappuccino's partner is going to Lanx also.

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