tag:blogger.com,1999:blog-126852961571725269.post4985437488649988581..comments2024-02-24T06:25:59.743-08:00Comments on The Spine Blogger: Surgeon Owned Distributorships: New Trend or Passing Phase?Musculoskeletal Manhttp://www.blogger.com/profile/14873819014357051373noreply@blogger.comBlogger34125tag:blogger.com,1999:blog-126852961571725269.post-33329281995259287692018-11-16T01:21:59.925-08:002018-11-16T01:21:59.925-08:00Thanks for sharing this valuable post. This inform...Thanks for sharing this valuable post. This information is very helpful and we hope to hear more from you. <a href="https://mosm.com" rel="nofollow">Meier Orthopedic Sports Medicine</a>Meier Orthopedic Sports Medicinehttps://mosm.com/noreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-26622823105778049872015-02-23T00:28:04.047-08:002015-02-23T00:28:04.047-08:00Thanks for the FANTASTIC post! This information is...Thanks for the FANTASTIC post! This information is really good and thanks a ton for sharing it :-) <br /><b><a href="http://www.drhipandknee.com/" rel="nofollow">Orthopedic Surgeon Los Angeles</a></b>Anonymoushttps://www.blogger.com/profile/00335816107872997558noreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-74491007633371427042012-06-13T15:17:10.115-07:002012-06-13T15:17:10.115-07:00Our company has helped surgeons throughout the US ...Our company has helped surgeons throughout the US create significant ancillary revenue streams through a very legal strategy we’ve developed. We are not a POD. We have a different structure that works. Basically, we are an implant design, manufacturing and marketing company exclusively for spine and orthopedic surgeons. We look to partner with surgeons (through an investment strategy) and become the distributor of surgical hardware systems. I would be happy to discuss our strategy with any of you further. mymedrep@ymail.com for further information.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-3060040545998719162011-04-14T22:07:32.908-07:002011-04-14T22:07:32.908-07:00Hey Dr Burton and Dr Steinmann, we are all headed ...Hey Dr Burton and Dr Steinmann, we are all headed to your hospital to offer them lower pricing than you are currently charging for your off-brand implants. Since your statements and position are that you have chosen to switch to implanting these backyard implants in order to save the hospital money, you better get ready to convince your hospital to bulk-buy your garage full of implants or come up with a compelling reason why you can't switch back to using the major manufacturers now. You want to be an implant distributor? Here you go.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-72449745966806039912011-02-16T11:50:58.585-08:002011-02-16T11:50:58.585-08:00Simple math for all the misinformation out there a...Simple math for all the misinformation out there about how loaded and how much money doctors/surgeons make. A spine surgery procedure pays a surgeon x; the hospital cost ranges from 4-20x! This is a free-market system right. Lets cut back or eliminate the middle-people (in some cases, there are even middlemen for the middlemen) and see what the cost to the patients, hospitals and insurance compannies (including Uncle Sam) would be! These big companies buy up their competition... no mention of those deals, RIGHT!loupeshttp://www.loupes.comnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-52967260379109948262011-01-04T20:09:21.069-08:002011-01-04T20:09:21.069-08:00I am a surgeon, I don't have a POD but would c...I am a surgeon, I don't have a POD but would consider it and would like to weigh in on a few things (some philosophical, some about PODs)<br /><br />First, the idea that the ownership in a distributorship would adversely affect an ethical surgeon's judgment as to how to tackle a problem in the operating room is ridiculous. There are over a hundred companies making implants now and the differences between the implants themselves are in general completely insignificant. There are two dozen companies selling implants that are excellent and FDA approved to physician owned distributorships. Is the medtronic pedicle screw superior to alphatec or integra? No. They are all the same. If you are well trained and know what you are doing,you can select appropriate surgical candidates, and perform surgery effectively it does not matter what implants you use. Some hospitals severely restrict surgeon choice in implants just because they get a good deal from one company but nobody cries foul that the hospital is hurting the patient motivated by profit in choosing implants. Most of you don't do spine surgery. I do it three days a week. If you know what you are doing, you get good results with anything that is FDA approved. There is zero reliable data to refute this.<br />I have no understanding of why some people have such animus against spine surgeons trying to make money off implants. Dentists get to charge for their implants. They charge a lot. They demand cash. Nobody cries foul when they do this. If you trust a surgeon to cut you open and manipulate the tissues of your spine, then I would trust that they aren't doing so for just money. This impulse for money would exist in the absence of implant income. In my community one neurosurgeon just lost his license basically for operating on any patient that walked in his door. The fee for service model rewards operating on more patients. Good surgeons see their patients, examine their patients, and counsel them appropriately on the risks and potential benefits of surgery before the PATIENT decides to undergo surgery. I have a PA but I see every patient before any surgery and I round on them every day they are in the hospital.<br /><br />Every american is entitled the american dream. Making money is not everything but doing so allows people to do the rest of what makes life rich and rewarding. The comments above reflect a very odd point of view to me. Just because spine surgeons make good livings, if they find another way to improve their incomes it somehow must be unethical or wrong? Stop for one moment and think about that. Surgeons are in general good people who care about their patients' outcomes. They are compensated well compared to some, not so well compared to others. Every single surgery we do represents a journey we are taking with the patient that has a lot of risk. Nobody else in that room takes the risk that the patient does, but the surgeon is definitely in second place.<br /><br />In a medicare fusion case, the rep will routinely make more than the surgeon does. All he does is show up with some screws and rods, fill out the paperwork and go home with anywhere from 8-25% of the ridiculously high implant cost. His only risk is that he won't get called for another case anytime soon. Anyone who thinks that is a better situation for the public than for the surgeon to make a little more on the case, have the choice of his rep to reliably deliver the hardware and support him/her, and significantly reduce the cost of implants to hospitals and payors is simply delusional.<br /><br />In the end, the surgeons are the sharp end of the stick in this battle. They know the pathology, they know the options for how to handle different anatomy problems (in the end all a surgeon can do is change anatomy), the patient has trusted them to try and make their life better. Who is better to decide what implants to use and to make a profit on the efficient delivery and use of those implants?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-70059564564977868642010-11-29T18:59:52.360-08:002010-11-29T18:59:52.360-08:001. The primary benefit for an implant manufacturer...1. The primary benefit for an implant manufacturer is the elimination of the distribution, sales and marketing costs that most manufacturers support. This can add 30-40% of the cost of an implant to a hospital.<br />2. My rep is well trained, very reliable and provides excellent service at a reasonable salary.Paul Burton, D.O.noreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-84629290081127985942010-11-15T07:51:43.560-08:002010-11-15T07:51:43.560-08:00Two questions for everyone:
1) Can anyone comment ...Two questions for everyone:<br />1) Can anyone comment as to what (if any) benefit PODs are to the implant manufacturer? Obviously, the streamlined process of PODs saves cost which is a good thing for physicians in leu of the declining reimbursement for these procedures. But is there a benefit to the manufacturer (other than selling more stuff to certain PODs)?<br />2) For the physicians who are part of a POD; have you identified any gaps that exist now that you're not working through a distributor and/or manufacturer sales rep? Are you finding things like education, service, or anything else that may be lacking now?<br />Thank you for your comments!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-54513039940805856482010-10-06T09:24:36.170-07:002010-10-06T09:24:36.170-07:00Anonymous 8:08, I would like to speak with you abo...Anonymous 8:08, I would like to speak with you about setting up a legal and ethical POD. Recently, I have been trying to research info on this subject. Can you help me?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-58330865423784859282010-09-02T15:59:40.362-07:002010-09-02T15:59:40.362-07:00what jurisdiction of the federal government would ...what jurisdiction of the federal government would investigate this? FBI?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-77646806638492121302010-08-19T18:19:28.875-07:002010-08-19T18:19:28.875-07:00To Anonymous 8/4, 1:17PM
This is Anonymous 8:08. ...To Anonymous 8/4, 1:17PM<br /><br />This is Anonymous 8:08. I would be happy to speak with you about setting up a legal and ethical POD based on our model.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-71000557195540847652010-08-11T18:39:23.896-07:002010-08-11T18:39:23.896-07:00A friend of mine who is new to Spine works for a d...A friend of mine who is new to Spine works for a distributor that keeps pushing PODs to the Spine Surgeons. She asked me about PODs, but I had no idea so I ended up here after searching the internet. To me this sounds like a shady deal, my question to those more experienced is: should she be concerned about working there, and is there a chance that she can get in legal trouble if she's told to push the surgeons into a POD created by the distributor and surgeon/s?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-14059194920563139042010-08-04T13:17:35.392-07:002010-08-04T13:17:35.392-07:00anonymous 8:08 would love to talk with you about h...anonymous 8:08 would love to talk with you about how you structured and how to structure this concept. I have been thinking of this for a while and feel that this will be future of this industry to help contain and control cost while maintaining excellent care!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-73642033293836518742010-07-30T19:28:34.620-07:002010-07-30T19:28:34.620-07:00We'll see. Get a real job.We'll see. Get a real job.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-79045432090387318992010-07-30T08:49:30.571-07:002010-07-30T08:49:30.571-07:00A POD is a POD and if you read the comment from th...A POD is a POD and if you read the comment from the OIG they are speaking to all POD's. This is a landmark decision and if you had any legal knowledge whatsoever you would realize this. Stick to practicing medicine or they will be knocking on your office door soon enough.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-27722415304328610892010-07-29T17:46:46.180-07:002010-07-29T17:46:46.180-07:00You are such an idiot! Read the settlement again. ...You are such an idiot! Read the settlement again. This blogsite is SPINEblogger, not LITHOTRIPSYbloggerAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-32992040337948862672010-07-26T15:41:07.216-07:002010-07-26T15:41:07.216-07:00Sounds like you spoke too soon. The OIG just won ...Sounds like you spoke too soon. The OIG just won a 7.3 mil dollar settlement against a POD two days after your post. I would rethink your logic and stick to practicing medicine. “This settlement sends a strong message that companies, including those with physician-owners, cannot use federal health care beneficiary referrals to line their pockets by securing business from hospitals or other providers….We continue to have serious kickback concerns when companies link investment opportunities to the ability to generate business and offer returns on investment that are disproportionate to business risk.”Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-89311179407093306022010-07-06T20:08:42.796-07:002010-07-06T20:08:42.796-07:00Wow.....that last comment is clearly from a curren...Wow.....that last comment is clearly from a current distributor rightly fearing for his existance. I am a surgeon who has nothing to do with Alliance Surgical who has recently done a significant amount of legal research and helped to set up two successful, surgeon-owned distributorships in the Midwest.<br /><br />Your comment about the DOJ couldn't be more off base. In fact, the DOJ and the OIG have given every indication that they support the idea because prior experience with physician owned companies (eg. surgery centers) has proven that care can be streamlined, and significant cost savings can be realized without compromise of quality. This sentiment will only become stronger with the inevitable endorsement of NASS and CNS.<br /> <br />Finally, we are all aware of manufacturer-specific data which indicates that their product is superior in every way to everything else. Manufacturing registries from other countries is probably the worst evidence you could quote. While our FDA certainly has its faults, it does ensure the excellent overall quality of everything 510K approved in the US.<br /><br />Maybe its time to consider placing yourself in a position where you are more necessary.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-68655669281887155392010-06-10T18:43:40.229-07:002010-06-10T18:43:40.229-07:00Wow, last comments are obviously from the surgeon ...Wow, last comments are obviously from the surgeon owners of Alliance Surgical.<br />Their comments come off very arrogant and bitter toward the medical device distributors. It obvious they are very bitter that anyone but themselves could possibly carve out a decent financial existence, so they found a way to make as much money or more as any medical device distributor in the market. It seems they will try to convince unsuspecting surgeons (In the near future you will be prosecuted by the DOJ) into entering long term, binding agreements with them to "manage" their distributorships. In return Alliance Surgical will handle all the leg work to ensure that their "distributorship" is managed efficiently and legally for a "nominal" fee. They will also help select the medical device company the best meets the need of the surgeon group that contracts with them. I'm sure they also receive a "nominal" fee from the medical device company for facilitating this arrangement. <br />The Anti-Trust laws will eventually catch up with all these money motivated individuals and the long term effects will be devastating. <br />Don't be naive or greedy. As a patient it scares me to death that a surgeon would be motivated my his reimbursements as to which device he decides to put in me. Didn't a heart surgeon in Redding recently undergo criminal prosecution for performing unnecessary procedures that were money motivated? Didn't the DOJ recently prosecute the medical device companies for illegally enticing/influencing surgeons with monetary "kick-backs" and illegal "consulting agreements"? How does a Surgeon Owned Distributorship differ? Isn't it obvious to everyone involved that the surgeon's decision as to what to implant is best for their patient will be influenced by the fact that they do or do not have a financial interest interest in the medical devices being offered?<br /><br />A comment above suggested that if a implant is ASTM-compliant then its just as good as any other ASTM-compliant product. This is simply not true. In my research data suggests that any product that meets basic requirements can be ASTM-compliant but that the device design and manufacturing process can and does vary widely between manufacturing companies. One implant being better than another plays a critical role in determining the post op satisfaction that a patient experiences as well as the longevity of the implant in a particular patient. Especially in regards to the varying activity levels and special considerations that vary among prospective patients. If all "compliant" implants were equal wouldn't the various registries show similar results among manufactures? They don't, the medical device registries in various countries suggest that certain implants do better than others simply because of variances in design and manufacturing. <br />It seem to me the founder and purveyors of Alliance Surgical and companies like them are simply hypocrites. They are capitalists attempting to make a buck and attempting to destroy their competition through propaganda. Not unlike a lot of other unscrupulous capitalists in America. <br />Whatever it takes, right?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-42019586686443342442010-05-24T20:48:49.339-07:002010-05-24T20:48:49.339-07:00these companies are growing, not falling by the wa...these companies are growing, not falling by the wayside. they are more aggressive than ever. as long as they dodge advamed, the big companies will suffer. goliath goes down.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-15319241458849809582010-05-15T08:01:16.017-07:002010-05-15T08:01:16.017-07:00In complete agreement,Anonymous. Spine Distributo...In complete agreement,Anonymous. Spine Distributor's comments seem like a whole lot of sour grapes in an industry that is finally righting itself from the burdens of the handsomely paid middleman. In fact, spine distributorships in their current form, more often than not, represent the unnecessary"fat" in the system. They are often given 20-35% off the top for providing (not manufacturing) expensive hardware. This is a percentage that ALL manufacturers would like to see go by the wayside as more efficient distribution models are developed. Hospitals have also been strong advocates of the SOD model because of years of being gouged by distributors in their current form. It seems that the SOD model benefits everybody truly invested in the care of the patient (the surgeon, hospital, and manufacturer), but not the current distributor. <br /><br />The fact of the matter is that the current distribution model is inefficient and cumbersome. Literature exists that the SOD model saves costs for the insurer, hospital and manufacturer. The implication that running a distributorship requires any type of business acumen is not to be taken seriously. Many individuals in this line of work are individuals in secondary positions in healthcare (scrub techs, PAs, nurses) who have found a better opportunity as a result of their relationships with certain surgeons. Why should surgeons not be able to exploit the same opportunity?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-78894085657997966962010-05-06T19:22:35.278-07:002010-05-06T19:22:35.278-07:00interesting points, SPINE DISTRIBUTOR... can you h...interesting points, SPINE DISTRIBUTOR... can you honestly sit there and claim that your ASTM-compliant pedicle screw is superior to the next company's ASTM-compliant pedicle screw? how about comparable--which is why these standards were adopted. the only thing that sets companies apart from one another is the packages they are willing to offer surgeons based on production! and as a distributor, you are even less subject to the corporate AVMED-compliance standards that have been adopted by almost every major company to throw the DOJ off the scent... so how was your last golf junket to ireland with your top-producing surgeon? you also referred to companies and reps that surgeons have long trusted to bail them out in the OR... i have not once, in 10 years of practice, had a company contact a patient regarding a broken pedicle screw or rod. and every rep that sees hardware failure in the OR has "never seen anything like that before". so one of the reasons that PODs will be so successful, is that since the companies insist on shifting the liability for failures to the surgeon, the surgeon will now be SOLELY responsible for his/her outcomes, both medicolegally and monetarily. additionally, in the area of business practices, name me one other profession besides medicine that is not allowed under the current tax code to write off bad debt (for services rendered to uninsured patients that are given the same medical care that your family enjoys)...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-88371245151170361172010-02-14T18:33:19.388-08:002010-02-14T18:33:19.388-08:00Talking Meds, I find it a very common source of fr...Talking Meds, I find it a very common source of frustration from surgeons that someone else may make more money than them (Gasp!) Where is it written that surgeons have to be paid the most money? The administrator of a hospital operates a massive businees, with multiple divisions, thousands of employees and his decisions have a far greater weight on his shoulders to be profitable than any surgeon. (By the way, I am not an administrator, but it irks me to hear surgeons say things like this). I am a distributor and I will tell you that there are reps that make more than the average surgeon, but it is rare. Spine surgeons are very handsomely paid, even though most of them have never had to manage any portion of their business themselves, never had to market themselves, and for the most part have no idea how to run a business. <br /><br />Concerning the POD's, none of them comply with a particular safe harbor that states that the POD must market their products in the same manner to investing surgeons as non-investing surgeons. That is impossible to do. You bring a pro-forma to one doc and a sales brochure and a sample implant to the other. <br /><br />Another thing to consider, entrepreneurialism is all fine and dandy, as long as the surgeon stays out of the business of selling products to himself (directly or indirectly) because you are human and it will influence your decision making. I would bet the farm that the docs you know in that POD arrangement had many reps show them many good products that they never switched to because of their comfort level with the product they were currently using and they probably had a rep that they trusted that always had what they needed and helped them out of many binds in the OR. When they signed the POD deal, how long did it take them to throw those values out the window and switch to the POD products? What are the chances that the POD products were better than what they were previously using. What are the chances that they no longer have a rep that is knowledgeable and conscientious? I would even bet that the POD products are not significantly less expensive.Spine Distributornoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-88379337033383590752009-12-23T16:27:20.190-08:002009-12-23T16:27:20.190-08:00A jaded view, but is it far from the truth?
In th...A jaded view, but is it far from the truth?<br /><br />In the old days, a surgeon talked to his patient, did a thorough physical exam, if necessary selectively ordered tests, arrived at a diagnosis, determined the best treatment to cure the ailment, and if that happened to be a surgical procedure, he went ahead and performed the surgery. While in the OR, he was the captain of the ship, and the staff, who were not his employees, had to follow his directions. Only the anaesthesiologist was allowed to interrupt in case the vital signs of the patient necessitated it. Where appropriate, the surgeon would use implants, of which there were a limited number available at reasonable cost (certainly pre-FDA), and in which he had no direct financial interest, even if he had helped develop them. Post-operative follow-up was done by the surgeon himself and again involved spending time and talking with the patient.<br /><br />Today, the PA talks relatively briefly to the patient, does a quick exam, orders a battery of often expensive tests, and after a brief consultation with his boss schedules surgery, sometimes even when non-surgical options still could be considered. The day of surgery the surgeon briefly introduces himself to the patient, the resident and PA start the surgery and the surgeon comes in to implant very expensive hard- and software in which more likely than not he has some financial interest. Next to the necessary staff, the OR often is populated by individuals who want their wares used, so that they can earn a commission. On occasion there may be 15 people in an OR where only one patient is being operated upon..... The patient is lucky if during follow-up he sees the surgeon himself more than once. If the outcome of the surgery is not as the patient expected, the reasons given are the patient's psyche or life style, fibromyalgia, RSD, sacro-iliac dysfunction, or failure of the implants, but rarely the admission that the diagnosis or the type of surgery performed may have been wrong. That possibility will be suggested by the next surgeon the patient consults, and the whole circus may begin again.Unknownhttps://www.blogger.com/profile/00670352669210786388noreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-61559005513024170672009-12-23T15:16:41.433-08:002009-12-23T15:16:41.433-08:00Based on the initial comment, it seems that there ...Based on the initial comment, it seems that there are surgeons that exhibit a sense of entitlement. When the patient cries out, God don't let me die, their talking to God the Father, not God the Surgeon. You gotta love whenever some surgeons claims if everyone in the OR was a direct employee of theirs the outcomes would be better. Now the staff is responsible for someone's crappy patient profiling, or the poor surgical technique. Maybe if y'all spent as much time managing your business as you do talking to your stock brokers y'all would be better businessmen.Anonymousnoreply@blogger.com