Wednesday, February 29, 2012


Finally, our lovable commentator has had his wish granted, Globust Goes Public?  NOT! Just kidding! Gotcha, didn't we?  We'll have to spare the celebratory non-sense for another day.  Would TSB have a shot at underwriting Globust? Highly unlikely. Anyway back to the real story.....

It was reported on February 28th, 2012 in a publication named Med City News that an "Orthopedic Device CEO was fined for distributing products without the FDA's approval." It seems like the FDA has reached a civil settlement with Globust (We haven't gone public.......yet) Medical for distribution of unapproved medical devices.  Seems like the mighty Globust is just a wee bit lighter in the pocket having to cough up $550,000 for the penalty, while David C. Paul, the firm's CEO had to personally cough up $450,000 for a total of $1 million.

During an inspection, and as required by law, back in 2010 FDA investigators had learned that the company had marketed its NuBone OSTEO.....INDUCTIVE product without pre-market approval or clearance as required by law.  In January 2009, the GLO-BUST had sought clearance, but the FDA had declined the request citing that the product was not substantially equivalent to legally marketed products, but it seems GLOBUST continued to do so even after receiving the letter.

The result?  The FDA then filed a complaint for civil monetary penalties against GLOBUST and the company's CEO.  Of course, what other recourse or action was left for the FDA?  When someone says no, it doesn't mean yes.  Now TSB is not even going to attempt to figure out how to state the word no in the Indian Language considering that the last time we studied about our Indian Brethren there were at least 110-115 languages spoken.  But no is no.  So here are some other ways that the FDA could have conveyed its message;

Nyet (Russian)
Nein (German)
Non (French)
Bu (Mandarin)
Ochi (Greek)
Ninc (Hungarian)

Wonder if old Dave had to cough that up out of his personal account or did the company spring for his faux pas, anyway, looks like his assistant Tatoo might not be accompanying him on his next go round when he walks the trade shows.  Until, then you know what Earl King would sing;

People see me but they just don't know, What's in my heart and why I love you so
I love you baby like a miner loves gold, so come on baby let the good times roll
Love is nice when its understood, its even better when you're feeling good
You got me flipping' like a flag on a pole, so come on baby let the good times roll

Let The Good Times Roll.

Sunday, February 19, 2012

Sunday's Funnies, Not So Funny

As the smoke settles from the former Stryker CEO Steve MacMillan's resignation, and, if the allegations are true that Stevie Wonder had a Wondering eye, questions must be asked of our readers, have we truly become a shameless society? Is leadership truly overhyped? And what does it say about Stryker?

Based on the latest stories that have graced major publications a la The Wall Street Journal and NY Times regarding POD's, POC's, the Blackstone and Orthofix DOJ settlements, the conviction of former Synthes executives and MacMillan's resignation, it has become evident that shameless behavior has become pandemic in our country.  Maybe, the fact is that "shamelessness" has become an accepted disease within the American gestalt.  Americans love to rationalize their shameless behavior.  As long as you win, haven't killed someone, or for that matter make lot's of money, it is okay to behave and act out in a certain manner.  As shameless behavior dominates our psyche what does it say about the direction this society and future generations are heading for? What kind of country are we becoming?  It's just not spine industry employees, it's athletes, entertainers, investment bankers, and CEO's, and worst of all politicians. We have lost our sense of humanity, we are slowly becoming that dystopian society that TSB once wrote about.

TSB is sure that the righteous will accuse us of being liberal, phony, or pandering to the weak, but the truth is that everyone must conduct oneself with some order for a society to truly prosper and for people to coexist. There must be balance when it comes to laws of the jungle. Man's selfish nature dictates why laws are necessary and government exists. You don't believe it? Wait until the curtain is pull backed on what's been going on in California in spine for years. Contrary to some of our readers opinions, there cannot be two sets of rules.  There cannot be one set of rules for you and another set of rules for us. Maybe there are too many companies, too many products and maybe money has come too easy becoming the driving force in many of your lives, but the reality is that contrary to popular opinion everyone cannot be a winner. Maybe that's part of the problem? Just look at your children, they are a reflection of your insecurities and behavior. Regardless of what you think, everyone cannot be a winner, no matter how far one stretches the rules or thinks that you are not breaking any laws. How many of you actually promulgate good citizenship and fair play all for the love of the Almighty Dollar? How many of you espouse free markets, yet use every tactic in your power to manipulate or rig the market? Disappointment is a part of life, making adjustments is reality. Too many people in this industry behave the same way that America raises its children, everyone must be a winner, everyone must succeed, everyone deserves a medal even if you finish in fifth place. You know what?  That's BS! That's why America has become what it is today. The bottom line is the pie is only so large and has to be shared by many people, some will win and some will lose and some will have to learn to live with the blues.

The recent California Dreamin' post exposes how many of you defend your unethical actions. Calling other commentators out on their anonymity, while you cloak yourselves in your own veil of secrecy, using sophomoric language, threatening libel as though some of you had a law degree, exposes your immaturity, insecurities and shamelessness. Justifying your behavior by casting aspersions onto the system doesn't excuse one from raping the system. Who do you think pays for someone buying implants at $3,000 and then selling them for $47,000?  We all do!  Who do you think will be hurt by this shameless behavior? The entire industry is effected! But you know who's to blame for this type of behavior?  We all are.  NASS, AANS, or CNS don't have the authority or the BALLS to step in and police its own members or peers. The companies CEO's and upper management teams look the other way using their best Wally Karew and Dave Lyons "Hear no evil, see no evil" defense because they have become the Streets bitch.  Surgeons and reps cannot control their urges or desires and hospitals have become nothing more than sweatshops for perpetuating an unhealthy society. This in itself exhibits our aberrant and sociopathic nature.  Don't believe it?

Let's use some examples. What would you do if you found out that a surgeon who had his license revoked was still practicing and collaborating with his peers to funnel workers' comp patients to a hospital, and the hospital was working with these people in concert to drive profits? How would you react if that was your mother or father, sister or brother, son or daughter? TSB is sure you would react with outrage.  How would you react if your family member went in with a degenerative problem at L5-S1 and was told that they needed a three or four level procedure? How would you react if your loved one went in for a simple ACDF and left the hospital in a hearse, because some surgeon used a product off label without truly understanding the consequences or biological response from using that product? Some of you may even go to extremes and take matters into your own hands. Well, this is why spine finally needs a thorough cleansing. The con artists, scam artists, the dealmakers, those that do nothing more than bilk the system for every nickel and dime that they can get out of the system while dragging the industry further and further into a death spiral. And yes fellow bloggers we have many people to thank, you know who you are, because we know who you are.

The waste and theft in our industry is enormous.  The U.S. spends twice as much for delivering medical care than the next most prosperous country.  The incentives for everyone involved is misaligned.  Fee for service is really not a healthcare system, it is a treatment sales system.  Don't believe it?  Come to California.  Patients must take control of their lives and health if medicine is going to change.  If 3% of all healthcare spending, an estimated $68-70 billion annually, is lost to fraud, California is definitely doing its best by contributing with its POC's and POD's.  Governor Brown should be proud that he oversees and encourages this illicit behavior.  Recently, it was reported that in the Sunshine State, aka Florida, Medicare fraud is bigger than the illegal drug trade. This is something that we should all be proud of.  Of course rather than reflection, many will respond that it is the politicians, insurance companies and lawyers fault.  And yes indeed, they do their best to add to the increasing cost of delivering healthcare.  Today, what we have is a market free-for-all.  Companies hire surgeon consultants and rationalize that this does not influence their decision making abilities, yet, behavioral research has proven that incentives create reciprocity.  So in closing, maybe its time for the DOJ, the OIG, and the FBI blow the lid off of this industry. But until some CEO's, surgeons or distributors don an orange jump suit, it will be business as usual. TSB wants to know what our readers think?  Maybe what many of us have found out is that it pays to commit white collar crime.  Some poor schlep rips off a gas station for $50 and serves 10-15 years, while some companies rip off the taxpayers and the government and they get a slap on the wrist and the proverbial whitewash in their settlement.

What I want, I want now, and it's a whole lot more anyhow
I wanna climb a mountain, I understand all destructive urges
it seems so perfect I see no evil


Monday, February 13, 2012

NJ Spine Society Emergency Meeting

Dr. Mitchell Reiter, President of the NJ State Spine Society has called for an emergency meeting to be held on February 15th, 2012 at the Sheraton Tara Hotel located on 199 Smith Road in Parsippany, NJ. If there ever was a Call To Arms, this is a meeting to collect input and coalesce NJ Spine Surgeons to address a direct attack on spine procedure reimbursement.

If there ever was a call for unity, this is the meeting.  A message to all NJ spine surgeons, if ever you were going to talk the talk, its time to walk the walk. Action will speak louder than words. Forces in the State are threatening the current out-of-network providers with legislation that if effected will hinder your ability to practice medicine and earn an fair wage for your efforts.

The matter at heart is the PIP fee schedule, which is to be overhauled.  This schedule threatens caring for MVA victims financially untenable for NJ spine surgeons.  The patients freedom of choice is being threatened.  The current crisis is predicated on the ideas of some influential individuals in the State to change the manner in which out-of-network billing for spine surgery is performed.  The fundamental rights of patients' and surgeons' to have freedom of choice is being threatened. If spine surgeons in the state are not ready to unite, the likely outcome will affect the future of all Garden Staters.  So NJ Spine Surgeons do you have the cojones to unite and fight, or are you going to roll over?

Spine Surgeons of the Garden State Unite and Fight.

Who knows maybe the NJSSS will adopt Twisted Sisters famous song of years ago

"We're not going to take it, no we're not going to take it, we're not going to take it anymore!!!!!!!!!!

Thursday, February 9, 2012

California Dreamin'

As the late James Brown once sang,  Huuuuuuuuuuuuuuh!!!!!!!!

Super highways, Coast Coast to Coast
Doctors, Lawyers and Scam Artist are the Toast
Living in America, eye to eye station to station
Living in America hand to hand across the nation
Living in America got to have a celebration

Well TSB doesn't know why it took so long, but our friends at the WSJ, the bastion of capitalism, finally broke the story today entitled, " In Small California Hospitals, the Marketing of Back Surgery."  Yes Spine Nation, Mssrs. Carreyou, McGinty, and Millman had finally provided the public with an expose that was well, as Stephen Stills would say, "it's been a long time coming."  It seems that the Tri-City Regional Medical Center and Pacific Hospital have been singled out by the authorities as incubators rife with alleged corruption, involving doctors, lawyers, hospital administrators and former convicts.  Before we elaborate on this breaking story, has anyone ever wondered why people eventually get caught?  Well let's put it this way Tri-City billed workers' compensation insurers $65 million up from less than $3 million three years earlier.

The man behind the curtain helping incubate this business was one Paul Richard Randall a consultant to whom Tri-City had paid millions of dollars in marketing fees.  Here was his role;

  • Bring cases to the hospital by recruiting surgeons to operate there
  • Supply medical implants for the surgeries through distributorships he owned
By last August, the U.S. Attorney in Los Angeles had prepared a charge that if filed in court would accuse Mr. Randall of conspiring to inflate the cost of spinal hardware and use a portion of the proceeds to pay "kickbacks" to surgeons referring patients to Tri-City.  Mr. Randall's defense has been that he is just one of a dozen distributors who mark up the price of surgical hardware and "there's nothing illegal about what I'm doing, my lawyer tells me."  As for the alleged kickbacks, Randall was quoted as saying, "that's not true."  Just a word of advice to Mssr. Randall, "Quelle Horreur, you actually believe what your attorney tells you?"

The status of this investigation is unclear and no charges have been levied as of yet, by the U.S. Attorney in Los Angeles.

As for Tri-City, a hospital official stated that they ended their relationship with Mssr. Randall last year after it had outsted the executive who had hired him.  Based on public knowledge, an internal investigation is under way at Tri-City and that numerous "improprieties" have been found.  A lawyer conducting the internal inquiry said that the hospital did not know that Randall was inflating the cost of spinal-surgery hardware until late 2010, and it was never aware of any possible kickback to doctors.  Duh!!!!  As this expose unfolds one has to wonder whether those involved at Tri-City were living in the Twilight Zone.  TSB can hear Rod Serling, "The smoking gun leads to the shadowy tip of reality, you're on the through route to the land of the different, the bizarre, the unexplainable....go as far as you want on this word, this scam can go as far as you would like on this road, it's limits are only those of the mind itself."

Let's look at some facts.  California employers paid $7.1 billion in insurance premiums to cover workers' comp liability in '10.  Spinal surgery paid for 40% of these claims up from 30% in 2001. 

Mr. Randall, a 52 year old entrepreneur began his career as a hospital marketeer in the mid '90's after serving a brief stint in the Terminal Island Federal Correctional Facility in Long Beach Harbor, California.  Upon serving his time, he went into business with Michael D. Drobot, the owner of another small hospital near Tri-City called Pacific Hospital of Long Beach.  TSB is sure that a few of our readers have their own stories regarding Pacific.

For a decade, Mssrs. Randall and Drobot operated a business that arranged for MRI services. Randall introduced Drobot to doctors to increase spine surgery business at Pacific according to a person with knowledge of the arrangement.  As Mr. Drobot acknowledge through a spokesman, Randall introduced a "few" doctors.  Gotta love that "a few."

What is fascinating about this story is that finally someone has sunk their teeth into an industry that has been another of our industry's dirty little secrets and has become so lucrative that there are private equity investors, chiropractors, surgeons, lawyers, and middlemen scamming and conniving to take advantage of some poor and uneducated migrant worker all for the love of the Almighty Dollar.  The PEI's provide the necessary capital, the lawyers research the law to interpret potential legal violations, the surgeons do the dirty work, and the middleman, well let's just put it this way, they end up taking the fall when things start to unravel. But back to the story.

Mssr. Drobot created several businesses focused on workers' comp patients; 

  • A Van Service to shuttle patients back and forth
  • A provider of Spanish Interpretation
  • A distributorship of metal implants
Between 2001 and 2010 Pacific performed 5,138 spinal fusions, an average of 571 surgeries per year, and billed $533 million, which was three times as much as any other hospital in the state, including much larger facilities.  As usual a business dispute between the two men resulted in Mssr. Randall moving to Tri-City. As a business consultant at Tri-City, Mssr. Randall was paid $3.2 million between 2008 and 2011 as a business development consultant.  Randall obviously understood how to play the game, acting as a distributor, his distributorship would purchase hardware and resell it to Tri-City.  So here is the legal catch, California's WC Division permits hospitals to bill separately for spinal implants, rather than include their cost in the overall charge for surgery, as in the case of Medicare and Medicaid.  Since the California WC Division doesn't put a limit on how much a distributor may mark up the cost of implants when it sells them to a hospital, it does restrict how much a hospital may mark up its own implant cost when it bills an insurance company.

Mssr. Randall's distributorship imposed some steep markups, invoices revealed.  Invoices for 16 spine surgeries at Tri-City between July 2010 and March 2011 for which suppliers charged Mssr. Randall's distributors $326,000, while his distributors in turn charged the hospital $1.1 million, nearly a 400% markup.  Here's where people start to get greedy and rockets red glare while bomb's burst in thin air, in 2010 Randall submitted an invoice for $42, 467 for hardware used in surgery that was purchased at a price of $3,600.  Could it be that Mr. Randall was inflating the cost of his implants to pay chiropractors and physicians kickbacks of approximately $15-$20,000 per case?  By August of 2011 , the federal prosecutors had prepared a proposed pleas agreement for Mssr. Randall, as of this expose, he has not signed it.

Today, Tri-City has initiated policies that include requiring vendors to attest that they comply with all applicable laws and regulations.  In addition, a legal spokesperson for the hospital is examining some "highly questionable transactions" that a former chief executive "caused the hospital to enter into with third party vendors."  The former CEO Arthur Gerrick was removed from this position for misconduct, according to the hospital's general counsel, Beryl Weiner.  Weiner ended Tri-City's relationship with Mr. Randall last summer after receiving an anonymous letter that described his criminal past.

As this story continues to unfold many questions need to be answered. The first question is how does a hospital sign a business development consultant and not run a mandatory background check?  What type of surgeon operates at a facility that mandates use of products that the owner of the hospital distributes?  How does an assisting surgeon make a statement that the outcome had nothing to do with the surgery?  Dipshit, if the patient didn't have the surgery, the patient probably wouldn't have died. What, did the product kill the patient?  Or, did poor surgical judgement?  The reason you go to medical school is to use your education as a guide to make prudent operative decisions.  

TSB could hear the outcry, you socialist, you are anti-business, you don't understand free markets, but here's the reality, let alone the scrutiny that Carreyou, McGinty, and Millman will receive.  Each and everyone of you that works in this industry in sales and wakes up in the morning to provide a better life for you and your family, must be angry.  You should out these people given every opportunity that you get.  This is why delivering healthcare in this country has become nothing more than a free for all.  Lawyers, Chiropractors, Surgeons, Hospital Administrators, and Middlemen attempting to stay one-step ahead of the law, while they abuse the system for nothing more than financial gain, and take advantage of poor uneducated people.  As for the migrant workers' family, they should sue the ass off these surgeons, the hospital, the hospital CEO, the hospital attorney for incompetence because it is easier to look the other way than confront the problem head on.  TSB wants to know what my comrades in the Long Beach area think? Let us know your experience with Tri-City and Long Beach, because we are sure that if there are a dozen distributors like Mssr. Randall, there are quite a few hospitals along the Coast that are involved in these types of deals. As the O'Jays use to sing;

Money, money, money, some people got to have it
Hey, hey, hey, some people really need it
Hey listen to me, y'all do thangs, do thangs bad thangs with it.
For the love of money people will steal from their mother, their brother

Wednesday, February 8, 2012

Happy Trails To You......

On February 6th, 2012 in a formal press release, Orthofix International's President and CEO Darth Vater, you don't mind if I call you Darth, announced that the company had made significant progress in resolving several legal matters with the Big Bad U.S. Government, aka the Boogie Man, you know the people that protect your helpless asses when the terrorists come to get you. These matters (nice word) aka alleged crimes included;
  • Reaching an agreement in principle to resolve the U.S. Government Investigation of Blackstone Medical Inc., or is it STINK.  The stench will follow the Fixx for an eternity.
  • Reaching an agreement in principle with the DOJ to settle violations of the Foreign Corruption Act Oh Mexico, it sounds so simple I just got to go
  • Finalizing definitive agreements to resolve criminal and civil matters related to the Bone Growth Stimulator, BZZZ zap BZZZ Neon
Seems like "The Fixx" is a little lighter in the pocketbook, like around $80 million in total give or take a few shekels.  Oh we know, they will acknowledge that this was a win for them, but then again pissing money into the wind seems to be the way to go.  Hey Darth, if you're treating your ex- comrades in arms to some bonus money how'z 'bout sending TSB some cash or taking care of the little people in McKinney?  The bigger question is will this change things, and will the mighty DOJ and FBI press on and file criminal charges against the Three Amigos, Lucky Day, Dusty Bottoms, and Ned Nederlander?  Relating to the first question, this isn't going to change a damn thing until some people are picking up garbage along the 5 in their Orange County Jump Suits, as for the FBI, well TSB just doesn't believe that they will press on even though there is a Las Vegas long shot that something might materialize.  Hey Amigo's just imagine what it would be like when you're on the receiving end, "come on squeal  like  a piggy........., now that would be a real payback."

As for the final settlement, it is only fitting that the DOJ and US Government press on.  Get every penny that you can, squeeze their asses so hard that the BOD at the Fixx will feel it between their ears.  As TSB predicted many years ago, arrogance does have a price and karma does eventually catch up to you, no matter how fast you run.  Obviously those at "The Fixx" will tell everyone that this was a win-win, but in reality it was a lose-lose.  The only saving grace is that no one's ass was thrown in jail.  Hey who knows, maybe the DOJ and FBI will squeeze the man with the fake mustache if they continue pursuit? Anyway as for those that had faith in the system, a win is a win regardless what those corporatistas say, and as the winner rides off into the sunset a fitting tribute is deserving for one of our own, who endured, who was ridiculed, who was called many names, but in the end, sometimes just sometimes JUSTICE PREVAILS even if it isn't perfect and has some blemishes.

May you never ever think of the Spine industry, ever again,  may your days be filled champagne dreams and caviar wishes, and as you ride off into the sunset, remember what  Roy and Dale would sing;

Happy Trails to you, until we meet again, Happy trails to you keep smiling until then
Who cares about the spine industry when we're together, Just singing our song Orthofix is under the weather,  Happy Trails to you until we meet again.

Some traits are happy ones and others are blue
It's the way you ride the trail that counts, Here's a happy one for you.
You're outta here.................................................................

As for all those that rode the Blackstone Gravy train and thought that their lives were going to be filled with easy living, you lose and she wins and as TSB stated in a previous post...."sometimes it takes a woman with balls to show a man how things need to get done."

Monday, February 6, 2012

Help! I Need Somebody's Help!

Well Nation:

Eventually, someone does respond to a Call To Arms.  Our first anonymous post is poignant and addresses one of the most pressing issues that each and everyone of you are challenged with on a daily basis.  If ever there was a post that drives a point home, well, it may be this one.  How many of you work for companies that work on a shoe string budget, have no understanding of inventory management,  or subsidize companies providing courier services? Some of readers will view this post as a someone complaining, while others will fully understand what this blogger addresses.  Who knows, maybe it will open some peoples eyes.  But one thing that TSB will say, if you don't have what you need or spend your day running around picking up and dropping of instruments and implants, you can't get the job done.  Kudos to Mr. Anonymous for a well written blog post.

For some time now we wonder about our industry cluttered with medical devices, implants, me-too products, trays and the like and dislike and continue to ask ourselves a series of questions that lead to the underlying “what matters” or ding an sich from which all things are created or problematic. Poor spending, trickle down economics, inflation, pricing issues, pay cuts, layoffs, fire your cover rep cause we can’t afford him, less innovation, more renovation, horrible training labs and bigger inventory warehouses so everything isn’t so cluttered and we can actually find stuff. And there lies the issue! Who is the number one user of FedEx in the world? One would argue that its Big Blue and Medium Red with a close second and maybe Little Purple growing every year. But the real question is why? Could it be possible that inventory management is one of the most crippling ipso facto of the medical device industry? The ugly duckling kept in the back room behind a locked door hidden in the depths of accounting books so that no shareholder can see the ugly truth. The life suck duck that couldn’t turn into a swan if you paid it to. Millions of dollars each year spent on lost inventory? No, you don’t say? TSB, how many reps have a garage full of product that no one knows about? How many implants do you have in your drawer? The FDA and CMS working together to create a universal system to track products because in the event of a recall they have not a clue on how to stop a faulty product from reaching a patient (site stent article). Seth Jayson from the Motley Fool even goes as far as using inventory as a method to track which companies will outperform others based on how long product sits on the shelf. Seth, hate to burst your prolific profiling bubble but that product is on the shelf because the company overbought to make up for a lack of efficient tools for projection on usage. Numerous companies are creating satellite distribution centers instead of creating new tech based supply chain management systems. Spending millions on new facilities full of sweat shop bean counters. Big Blue pulls the plug on an RFID based system because they can’t launch it effectively? What happened there? Verify this…

The problem or dare I say it shouldn’t be their problem is that reps in the field are ordained inventory managers in the field. Once it leaves the warehouse it’s off the grid so the only one who can monitor it is the field reps as if they don’t have enough to do. 

For example,

Inventory Manager:  Hello Johnny Rep, I need those trays back and if it’s late you owe me $100 per day, per tray. Yup, we’re docking your pay to help pay for this huge shipping bill we have. Why do we have this huge shipping bill you ask? Well, you see we don’t actually trust you. You see since you’re incentivized by sales and not turnover of loaner sets in the field we need you to ship that tray back priority first overnight back to the warehouse, which by the way is very costly, so we can begin our manual bean counting session so that whoever needs this tray next will have it available to them. Yes, there is a team of manual bean counters here in our warehouse and they put their fingers on every item to make sure it is present. Yes, we pay them a lot of money to do that which is also why we need to charge you a late loaner fee. Yes, I know automation would make this more affordable but my brother’s sister-in-law is really good at the bean counting plus the technology needed is a little high tech for my crew so we can’t really look at that as an option. I know it could save the company millions but I don’t work in the accounting department even though I manage the bean counters, and plus my brother’s sister-in-law’s kid needs a new pair of shoes and I’m tired of my brother hitting me up for a loan.

Johnny Rep: So this isn’t my fault and I shouldn’t be charged!
Inventory Manager: I know but sh*t rolls down hill and I’m afraid you’re at the bottom my friend.
Johnny Rep: We’re not friends. So you mean to tell me the real reason why it takes so damn long to get a customs request, or why my pay is constantly docked, or why the stock options I have are worthless, or why we haven’t innovated anything great in the past several years is because we’re pissing all of our money away on inefficient inventory management. Why don’t you teach your brother’s sister-in-law how to read a computer screen?
Inventory Manager: Because that would require me to implement a training program and yes, we spend roughly 20% per year of our revenue on my department but don’t tell anyone. (Cite source)
Johnny Rep: But I paid close to $20k in loaner fees last year and that’s a fraction of what my distributor overall paid. All because you want a bean counter to do something technology can do for a fraction of the price?
Inventory Manager: I know can you imagine if we absorbed those fees? We probably wouldn’t be talking right now and I would have no one to manage.
Johnny Rep: So who makes the call on whether or not to implement a new system that incorporates affordable technology which will probably pay for itself overnight?
Inventory Manager: I do, isn’t it great!
Johnny rep: So the largest cost factor of our entire company is basically in your control?
Inventory Manager: I know but don’t tell anyone because the tops think its R&D.

Why is a screw so expensive because for every one we lose we have to inflate the pricing. What do we do when demand is up and there doesn’t seem to be enough inventory to go around, we purchase more sets. What do we do when traffic is high, we hire more bean counters. Does anyone have an automated software system that tracks inventory in the field? Answer/guess: Less than 15%, if that. What do we do when there is a recall? We deploy a team into the field and rummage through offices, rep’s garages, hospital closets, SPD and anywhere else we can think of until everything is found. What do we do if someone dies because we couldn’t find what we were looking for because it was on the shelf in a closet we didn’t know about and someone used it in a case? We say its not our fault and refer it to legal.

Bottom line…yeah and while that’s compromised as well, we need better accountability because at the end of the day it could be your wife, your son or daughter on that table. And what now? Pricing cares and wears go out the window when morality and principle takes its course. Like Mel Gibson said so well in the movie the Patriot, “I’ve run my course”. Mr. Inventory manager if you can’t step up and say something then Johnny Rep and “the accused” pirates of the inventory closet should. There has been enough mowing in the field, there has been enough cutbacks and lack of innovation. Want to run lean and mean? Then Mr. Operations needs to look a lot closer at his operations and not the surgical ones. And Steve M. said, “Wide river runs open to the sea. “Run like a river and we’ll always be freeeeee, run like a river and we’ll always be freeeee.” Wide river carry me back home. Run like a river to the setting sun. Run like a river that has never been won!” Mr. Operations you’re never going to win if you open your eyes and create a transparent inventory management system that utilizes technology to meet the objective congruent with not only your sales force but the FDA, CMS and the like. Go big, or go home! Better yet tell the shareholders the real reason why you don’t hit your quarterly numbers. Or here is a novel idea…search the internet for “medical device tracking system”!! Money is pouring out of our pockets and into the sea and water is flooding the boat and we’re all about to sink. 


Please ask the readers and more specifically the reps how familiar they are with this issue. Ask them what happens when the tray they need is not available or mysteriously missing or not at par? How does that fare with their surgeon relationships? How much are they spending out of pocket for local courier fees? How big is this issue? Ask the FDA? What is “Unique Device Identification”? What is Bill H.R. 3580? Why is Depuy putting implant vending machines in hospitals? Why is Eisertech selling product on an on-line store? Why is the industry shifting away from autoclaving product and to pre-sterile packed items? Why is CMS licking their chops waiting for the UDI mandate to become effective at the end of this year? Why haven’t we done something sooner? Why are the reps and distributors footing the bill? What tech companies have viable solutions? Better yet what companies started by former distributors or reps have created solutions and what are they?

- WebOps Mobile
- Itraycer
- SurgiTrace
- Awarepoint
- Clearcount Medical

The list goes on! Be a Patriot TSB and post this to light a fire under someone’s arse to make this happen. Set the reps free! Support innovation, support new tech that serves the corp at its core and leads to a revolution that sparks the industry into a new era. The ball is now in your court.

With care and love for this industry,

- Anonymous

Sunday, February 5, 2012

Weekend Update

Well fellow spineophiles, it has become quite evident that for all of you shooting poison arrows at our hearts, no one, not one single commentator has sent us a post in the last 36 hours.  Could it be that all those pundits that criticize and mortalize this blog really don't have the literary skills that they profess? Easier said than done, huh? Who are the contenders versus the pretenders for 2012? What is endearing your customers hearts to you?  Biologics? Another pedicle screw? Another ISP plate? Another POD model?  Another POC?  Is it the money?  Is there a company out there that has the vision to combine staying power, meaning capital requirements, IP, and business model that makes small but incremental advances to overthrow the Big 4 or 5?  TSB thinks so.  Someone out there really understands that the days of 20% growth are somewhere over the distant horizon unless the accounting rules change. The world forever changed in 2008, and we may never pass that way again. There must be a company out there that understands long-term strategic thinking that is critical to executing ones objective whether it is building their company eventually taking it public, or flipping it to one of the Big Boys. No fellow purple people eaters, it's not you, so calm down. Why the rush?  Let's be honest, short-term thinking nearly brought the U.S. economy to its knees. Maybe short-term thinking is the primary reason the United States is no longer considered a market leader? And please before you start blaming the government, look at your own companies. It takes a solid linear thinker or thinkers to succeed.  It takes PATIENCE.  Ever wonder why some of the oracles in the industry continue to churn and burn through personnel and capital?  They are trying too hard to effect success. Results entail a process, something many people fail to place a premium on.You could espouse all the wonderful cliche's about management and teamwork, but it takes continuity and execution in order to effect change. Is your company reactive or proactive? Ever work for a company that changes its personnel and or business plan every year to two years? TSB bets many of you have either had that experience or have the name of those people at the tip of your tongue. The problem in spine is that it's not the banking/investment industry, there is no Big Brother, aka the Federal Reserve to provide a quantitative easing to some of the smaller companies. There are no CDO's or CDS unless you consider POD's as our contribution to the decay.  Over the last few months many of you have attended your NSM's and the question that the market needs to know, is whether or not you have anything that is going to differentiate you and the next guy?

You could read all the motivational books you want and take those anecdotal quips and deliver them to your sales team, but if you do not have the fire power (product) to sustain market share and incrementally grow your business, sooner rather than later, your customers and market forces will expose your deficiencies.  Is your company providing you with the necessary tools to get the job done?  Does your company really have a grasp of its clinical and financial trends?  Are they planning to make adjustments, hell, are you planning on making adjustments?  Considering that we work in a dynamic and less than loyal industry, TSB cannot blame a distributor or direct sales person for carrying multiple products, can you? There is no loyalty, there are only expectations and sometimes one has to take a step back and ponder whether some people are living in a bubble? So as most of you get ready for what will probably be a highly contested and entertaining Super Bowl, take the time to enjoy the agony and the ecstasy of the moment but remember that paying attention to detail (as painful as that is for some), process and a lot of luck will get you to the Big Easy.  TSB predicts that the winners for 2012 will be......................................?

Friday, February 3, 2012

A Call To Arms


TSB has been sitting back and reading some of the humorous, if not insane comments from our readers.  We love y'all, especially the ones that provide us a rationale for POD's or for how brilliant someone is financially. It is a wonder why the pharmaceutical industry invented Ritalin, you know the drug that is supposed to control hyperactivity, controlling actions, keeping one's eye on the ball. And some of you are actually correct in your observations when you comment that our readers have trouble sticking to the subject at hand, but then again, it's free, and considering the high levels of testosterone in this industry, what would one expect.  So what TSB and his 2 Live Crew have decided is that this week we will open our blog to anyone that is interested in writing a post.  That's right, you heard it here first, we are going to provide some lucky readers the opportunity to table a topic for discussion this week.  Here are the guidelines;

TSB has the right to edit any post that includes salacious innuendoes without being able to substantiate your facts.

TSB will not allow vulgarities directed at someone's spouse or children, or personal lifestyle

This is your opportunity.  You want to talk about Stem Cells give us the best you have, and save us the dog and hair stories.  You want to talk about an up and coming company, tell us why.  What is it about their technology that makes them a viable player in our industry.  Do you have metal, or PEEK that you truly believe is better than someone else's products, give our readers your best, and at the end, just remember what Sargent Joe Friday use to say, "Just the facts m'am."  So forward us post to   This my friends could be the most entertaining thing to hit this industry since Memphis.

C'mon babe you will be right
Open up my door, I'll be the key of your life
So aih aih aih getting' spinnin' around
I wanna let you feel my sound