tag:blogger.com,1999:blog-126852961571725269.post150560785506820819..comments2024-02-24T06:25:59.743-08:00Comments on The Spine Blogger: Weekend Op-Ed PieceMusculoskeletal Manhttp://www.blogger.com/profile/14873819014357051373noreply@blogger.comBlogger44125tag:blogger.com,1999:blog-126852961571725269.post-24912645106817983532010-10-19T06:52:52.871-07:002010-10-19T06:52:52.871-07:00It would be rather difficult to sell a patient an ...It would be rather difficult to sell a patient an unnecessary pair of prescription glasses. If your vision problem is coming from some other non-optical condition, you will not be convinced that the glasses will help. <br />Back pain on the other hand is an entirely different story. The patient only knows that their back hurts, and does not understand the multiple and variable causes, nor their appropriate and and initially conservative treatments. A patient should not be railroaded into surgery by the person that has charge of their well being. I'm not saying all, or even very many, are bad players, but monetary incentive is sure to pull more to the dark side.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-17986023855602917252010-10-07T07:31:04.807-07:002010-10-07T07:31:04.807-07:00I asked my wife, the most ethical and moral person...I asked my wife, the most ethical and moral person I have ever met, about the POD thing. Her first comment, which I found to be striking, was that the perscription glasses she had just purchased were from the store adjacent to the optometrist who owns the store and had just written the perscription. Interesting take!<br /><br />By the way, when do you think the office supply companies will be signing up surgeons for post-it note and writing pen consulting agreements now that pharma is not giving them away!<br />...SpineSellerAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-45194864643897046982010-10-06T19:31:08.971-07:002010-10-06T19:31:08.971-07:00I believe PODS are illegal and unethical because t...I believe PODS are illegal and unethical because they place a physician in a position of being both the decision maker in the spending of government money (Medicare $), and the supplier bidding for that purchase (a vendor). We don't allow it for defense contractors, and we won't allow it for docs.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-22736938898595598302010-10-06T11:52:30.740-07:002010-10-06T11:52:30.740-07:00So we can all agree that 4:08 is most definitely a...So we can all agree that 4:08 is most definitely a surgeon, and makes some good points. If a surgeon simply sees a rep as "someone who stands in a room and fills out paperwork," who can blame them for the overall jaded outlook on what a rep does? When innovation is lacking and procedures are routine, it can easily appear this way.<br /><br />I agree that, when the products are all similar, the natural dictation of the market if for price reduction and consolidation. If you're simply closing your eyes and ignoring this reality, then I'm sorry. We should not be shocked at this. <br /><br />Great reps will adapt and find ways to LEGALLY add value. Some good reps will likely have to leave. Bad reps will find ways to add value unethically. <br /><br />It is what it is folks.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-42009002860747026922010-10-06T04:08:36.922-07:002010-10-06T04:08:36.922-07:0012:35 can you not engage in a civilized conversati...12:35 can you not engage in a civilized conversation, you only show your true colors. <br /><br />You assume, and you know what thatmakes you, that all surgeons will over utilize to make more money and that is not the case. There is no conflict of interest if the surgeon is using good clinical products, still performs the same good surgery and saves the hospital money. The only one that is left out is you!<br /><br />Maybe your high salary for simply standing in surgery and filling out paperwork is the unethical conflict that this industry is having the problem with.<br /><br />Sounds like you have been stung by this, so I can see why you have the childish anger.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-60767468629548935262010-10-05T12:35:25.000-07:002010-10-05T12:35:25.000-07:0010:17 you are an idiot.
it's unethical bc its...10:17 you are an idiot.<br /><br />it's unethical bc its a conflict of interest. the surgeon is incentivized to do more surgeries, cut more levels, and can control more income.<br /><br />he can drive the price down so hospitals won't bark too much. and that is not a good thing for the reps in the field. f k2m!!!!!!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-74668589880539639352010-10-05T10:17:15.510-07:002010-10-05T10:17:15.510-07:00What is unethical about a POD? If the surgeons is...What is unethical about a POD? If the surgeons is using a FDA cleared product that is clincally as good as what he used in the past, saves the hospital money but makes a little money himself, what is wrong with that? It is unethical if you are not in on it and are hurt by it. How is a POD any more unethical than a manufacturer charging a 1000-1500% for an implant. I tell you what 10/1 9:52 cut your commission pass the savings on to the hospital. I bet a pig will fly out of my ass before you are willing to do the moral and ethical thing for the better good of society.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-45988893291506047722010-10-04T18:58:14.931-07:002010-10-04T18:58:14.931-07:00@ 6:41- dental and cosmetic surgery are mostly el...@ 6:41- dental and cosmetic surgery are mostly elective , (cosmetic implants). not driving healthcare and workers comp and medicare etc. through the roof<br />explaining to a patient they need 3 or 4 dental implants, or a womans breast implants is different than a patient comprehending a 1 level vs a 2 level fusion.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-47337926062528723512010-10-04T18:41:57.562-07:002010-10-04T18:41:57.562-07:0011:51 isn't telling the whole truth there...if...11:51 isn't telling the whole truth there...if MediPeek material is equivalent material from a Masterfile standpoint and truly is no different PEEK, and there has been a device already cleared against it, you could do as he says...(same case if you had Ti64AlV vendor switching)..you would still have to note it in your system's quality manual and your annuals for FDA in the event of an audit....make sure they can provide the clearance letter though!!<br /><br />regarding the POD model, something to think about is how the dental implant market, the breast implant market and any other non insurance based medical implant market works....the surgeon is the user AND the buyer... what about sports medicine? Go to any surgeon owned ASC and the user is also the buyer....surprisingly, in all of those scenarios, costs have remained relatively stable over the past 5-7 years...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-39311899252617821812010-10-04T14:50:46.691-07:002010-10-04T14:50:46.691-07:00jersey shore!jersey shore!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-46518254233520578262010-10-04T14:45:37.950-07:002010-10-04T14:45:37.950-07:00@ 11:51, the only thing you didn't apologize f...@ 11:51, the only thing you didn't apologize for is posting a blatant advertisement, which you should have. Imagine if everyone did the same for their company. I, for one, don't want to wade through such crap. How about we jump right back to our regularly scheduled programming?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-86391512271761718522010-10-04T11:51:37.469-07:002010-10-04T11:51:37.469-07:00I'm sorry to enter this discussion a little la...I'm sorry to enter this discussion a little late and change the subject here but............<br />How many "spine professionals" know that according to our FDA that if you utilize an alternative to PEEK Optima like MediPEEK you may not have to submit your existing device for a new round of 510(k). As of today the FDA has no regulations that mandate that an OEM must go through this when simply changing material suppliers. Now that being said, they the FDA, openly admits to not having a "complete understanding" according to one of the on staff Dr.'s Are there proper and things that must be done. Absolutely. Come see us at NASS booth 1875 and we'll be more than happy to help you navigate this.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-41917113660606597532010-10-04T11:33:51.004-07:002010-10-04T11:33:51.004-07:00Just catching up:
@8:59 - your excusing Michelson...Just catching up:<br /><br />@8:59 - your excusing Michelson from your rant demonstrates your ignorance. It's commonly believed that he didn't have the innovation, just the best patent attorney and a zealousness to run out and patent every idea he came across, his, or anyone elses. He sure revolutionized the level of greed and expectations among surgeons, though. Not sure that's a good thing. There are countless spine surgeons who actually innovated without any regard to personal enrichment, perhaps hoping only for professional recognition in the process, that much more deserved your excusing.<br /><br />And as for the future, only the option 3 that SpineSeller proposes (prices fall and available money for excess or unnecessary services and consulting agreements dries up) will lead to long term stability in the marketplace. 10/2 7:52 may hate the POD for ruining his revenues, and I dislike them for the ethical challenges they pose as well, but one has to recognize that the doctors sudden interest in the value of the products they purchase, is in the general public interest.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-75240980003673340552010-10-04T08:46:14.226-07:002010-10-04T08:46:14.226-07:00The spine related DRG's have had a meteoric ri...The spine related DRG's have had a meteoric rise between 2000 and 2010. For a basic lumbar fusion with no complications the national average in 2000 was $7,770. For the same procedure in 2010, the national average is $20,972. <br /><br />A couple things have factored into this rise - CMS averages the reported costs three years prior to come up with the next years payment. With the proliferation of Infuse, IBF's, and the advancement of technology that allowed for severe curvature of the spine to be corrected. <br /><br />Medicare has, of late, hit a critical mass whereby rates have actually decreased over the last year and are projected to decrease further over the next few years with the Whipsaw provision going into effect that will reduce rates by over 7% (in aggregate). <br /><br />With Obamacare hitting the doors and payors moving in lock step with CMS, there just isn't the room for higher costs, carte blanche, surgeons. When administrators look at the cost of a spine service, it is rather easy to tweek the vendor mix, save six figures, and come up with a spine service that makes - not loses - money. <br /><br />Then again, it would really be telling is to see a DOJ lawsuit akin to what happened in the Recon industry several years back!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-33135741910631984202010-10-04T08:15:39.523-07:002010-10-04T08:15:39.523-07:00The POD trend will not be stopped until the OIG ma...The POD trend will not be stopped until the OIG makes an example. The OIG will not move until this thing hits critical mass. I think it is clear that there is a great deal of momentum for POD's. I just dont think it is big enough for the them to get involved. Plus isnt is causing significant price erosion in the marketplace...dont you think the feds like that?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-20187129419304922812010-10-04T06:51:07.505-07:002010-10-04T06:51:07.505-07:006:57AM: It was a crunk night.
5:37PM: The complete...6:57AM: It was a crunk night.<br />5:37PM: The complete list of spine startups and no sign of slowing. <br /><br />http://orthostreams.com/?page_id=497Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-62696476972469729892010-10-04T06:11:44.927-07:002010-10-04T06:11:44.927-07:00Musculoskeletal man- you wrote at 4:45 am
"R...Musculoskeletal man- you wrote at 4:45 am<br />"Regardless what Puff Daddy sang, it's not all about the Benjamin's, if you truly believe that you're in for a rude awakening when that POD's eliminate the need for your job."<br /><br />wouldn't POD's be an argument that it is all about the money? If you are saying it's not, what other factor will make POD's eliminate traditional spine distribution? thanks in advance for the clarificationAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-88020880429129118022010-10-04T04:45:16.115-07:002010-10-04T04:45:16.115-07:00Who said anything about whining. The fact is, the...Who said anything about whining. The fact is, there are no ethics, integrity, and loyalty in this industry, let alone this country. Yeah, yeah, yeah, you're going to pontificate in your next comment about being a free-marketeer, unless it doesn't effect your 401k. The reality is that you've probably never been a soldier, and, you probably don't have a fortune, meaning that you have to go to work like the rest of us. If you haven't noticed, this industry just experienced a major downturn, does Inion, Pegasus, Vertebron, Applied Spine, Archus, and U.S. Spine ring a bell? Who's next? Loyalty, integrity, and ethical business practices are what built this country. If you don't believe that, why are there so many people bouncing around from job to job? Why is everything short-term? Why is there no stability or continuity in this industry. Why do people carry three different pedicle screws, two different cervical plates, biologics etc.....? Because there's loyalty? Right. Like any rational person, there has to be some balance in business just like in your life. It's a law of personal nature. Regardless what Puff Daddy sang, it's not all about the Benjamin's, if you truly believe that you're in for a rude awakening when that POD's eliminate the need for your job. PS: You're probably one of those people who never assumes responsibility for anything you do, because it's everyone else's fault except your own. It's call accountability, not entitlement.Musculoskeletal Manhttps://www.blogger.com/profile/14873819014357051373noreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-16645717993910878142010-10-03T21:41:28.836-07:002010-10-03T21:41:28.836-07:00It's all about the Benjamins....All the consul...It's all about the Benjamins....All the consulting agreements and the pathetic whining bastards on here going on and on about lack of loyalty...blah blah blah. Make your money while you can and move on. Soldier of Fortune could be our industry magazine. Get over yourselves.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-24805636100966722332010-10-03T17:37:21.090-07:002010-10-03T17:37:21.090-07:00How many spinal device companies are there? Yet, ...How many spinal device companies are there? Yet, I usually only hear about a hand full doing questionable practices. Relationships protect the distributor/rep from management decisions to replace them. No manager should ever have a stronger relationship than the local rep or they are f**ked. There is no spine company that deserves any loyaltyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-69438203913337230092010-10-03T15:27:19.865-07:002010-10-03T15:27:19.865-07:00From what I hear, SeaSpine was largely built out o...From what I hear, SeaSpine was largely built out of surgeon investment, raising potential concerns for conflict of interest. It seems like a decent bunch of guys running the show, but they do have that skeleton in the closet. The companies who are based upon that model will be hearing louder rattling from those skeletons moving forward.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-54344463468611443372010-10-03T13:55:58.675-07:002010-10-03T13:55:58.675-07:00I was surprised to see SeaSpine listed by 9:52 as ...I was surprised to see SeaSpine listed by 9:52 as an unethical company...MM gave them big kudos just one year ago as a strong company under $50M with great leadership.<br />Maybe 9:52 has an issue with a distributor in his/her territory?<br />From my experience, they're a great company to work with, and I know that they have some really solid designs in their pipeline right now.<br />Am I missing something?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-21835527769516673632010-10-03T13:13:06.638-07:002010-10-03T13:13:06.638-07:00That is the point. We have been trying to get rid...That is the point. We have been trying to get rid of pedicle screw fixation (PSF) since the mid-90s when TFCs were introduced. Unfortunately, BAK & Ray were the false solution, however they succeeded in doubling the size of the market. You have to give credit to companies like Trans1 and NUVA for ingenuity in thinking how to solve a problem differently, i.e. - how to get a fusion w/o PSF. That is why stand-alone ALIF (zero-profile), XLIF, and Axialif are interesting. <br /><br />In an effort to tie these devices together with the discussion topic, they are all successful with some exceptions. Axialif is declining because of pressure from big player influence, i.e CPT coding recommendations from NASS coding committee. This was also attempted with XLIF, but NASS members backed this up as an ALIF, otherwise NUVA stock would have continued to plummet. This is now happening to zero-profile stand-alone devices because the majors are protecting the PSF market. Lets keep the market locked into 1991 technology. As long as this happens the market will be driven by commoditization, greed, sloth, and corruption.<br /><br />There are still many problems to fix in spine. How do we get fusion without causing more harm than good? For many patients, this challenge is still unmet. Until then, either imitate or innovate. If you imitate, then you are part of the problem and not offering a solution.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-38604001384027071342010-10-03T09:27:54.724-07:002010-10-03T09:27:54.724-07:007:15. In my opinion, BMP-2 is the most significan...7:15. In my opinion, BMP-2 is the most significant 'new' advancement in spine. It eliminates the harvest site so that's good but the price can be a bit 'hard to swallow' (forgive the cervical pun). XLIF may offer advantages- and its doing well right now. In its day, stand-alone ALIF reduced OR time and cost. Jury is out on Trans1. I don't think its a standalone product and its too limited. <br /><br />A buddy of mine and I have been talking about the AAOS workgroup recent position statement saying that vertebroplasty is not supported by data. A big literature review with many papers- all pretty much disregarded in favor of the recent RCTs by Kallmes and Buchbinder. I think that baby is being thrown out with the bathwater on that one. How do a couple questionably designed RCT's trump all the collective experience? Unfortunately, this premature position statement makes it more difficult to do follow on RCTs on the subject. The medical community is all about Evidence Based Medicine. While I support that concept, we need to be careful not to distill that down to just one RCT and remember the principle that data must be repeatable by multiple investigators.Davidhttps://www.blogger.com/profile/11846646283559711437noreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-40685242005364927922010-10-03T09:13:41.217-07:002010-10-03T09:13:41.217-07:00At what is 7:48 laughing? Xialif is just another p...At what is 7:48 laughing? Xialif is just another product in the line wacky technologies invented for the purposes of selling a company. Xialif is dead (ref: stand-alone Ray Cage days)<br /><br />I also agree with the eco 101 theory...we are now experiencing "spine inflation"...too many companies chasing too few surgeons. However, when it comes to a clean transaction I insist that it is in the hands of the surgeon customer.<br />...SpineSellerAnonymousnoreply@blogger.com