tag:blogger.com,1999:blog-126852961571725269.post83837781806919200..comments2024-02-24T06:25:59.743-08:00Comments on The Spine Blogger: Spine SurveyMusculoskeletal Manhttp://www.blogger.com/profile/14873819014357051373noreply@blogger.comBlogger157125tag:blogger.com,1999:blog-126852961571725269.post-36571503615532447892012-02-16T16:51:58.419-08:002012-02-16T16:51:58.419-08:00been reported to higher ups before with no action ...been reported to higher ups before with no action takenAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-59520781678335432392011-07-18T23:30:40.949-07:002011-07-18T23:30:40.949-07:00Hello!
Pretty amazing stuff here. I am a surgical...Hello!<br /><br />Pretty amazing stuff here. I am a surgical neurophysiologist involved in spine surgeries often involving Nuvasive and other vendors. Some comments above are striking and down to the point, especially regarding the qualifications of reps to quasi perform neuromonitoring and touching patients. Please join me to discuss some of these issues @ Surgical Neurophysiology & Neuromonitoring Group @ http://lnkd.in/b4vXS9 or visit my blog @ http://neuromonitoring.wordpress.com<br /><br />Feel free to ask me any questions pertaining to the neuromonitoring perspective.<br /><br />Thank you, Musculoskeletal Man !Christopher Townsend CNIMhttp://neuromonitoring.wordpress.com/noreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-37303802828430443182011-01-17T14:35:08.217-08:002011-01-17T14:35:08.217-08:00Is anybody else fed up with trying to truly sell a...Is anybody else fed up with trying to truly sell and do our jobs in the OR, yet surgeons completely take that end of the business for granted? I think at this point, most suregons have forgotten the years of hard work and committement that goes on behind the scenes to ensure, in part, their cases go extremely well. Instead, they focus on the "newest guy's" consulting promises and want to know what you can do to combat their advances. When you do, they continue to use that as a way to leverage additional situations. If you don't, you discover they have their hands in many baskets. The future is scary......Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-79174213154522839412011-01-17T12:03:56.490-08:002011-01-17T12:03:56.490-08:00To Jan 25 8:20PM:
makes sense ... not hard to con...To Jan 25 8:20PM:<br /><br />makes sense ... not hard to connect the dots in Stryker's case based on their recent acquisitions. Their bag is "me too" but could command a premium due to the dedicated distributor and direct sales force The private equity owners are due for some sell offs and spin offs. Zimmer's flirtation with Spine has been a complete disaster (Endius and Abbott purchases and pathetic integration coupled with the failed Dynesys IDE).Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-61799697414293917542011-01-15T20:20:13.428-08:002011-01-15T20:20:13.428-08:00I am an M&A guy working for a big technology c...I am an M&A guy working for a big technology company looking to make an acquisition in spine. At the JPM event, I was quite surprised to be presented three spine companies as possible acquistion opportunities by a major investment bank. Stryker, Biomet and Zimmer. No NDA in place so I can disclose. <br />It is of course just their analysis but it makes sense.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-73906089862099732002011-01-15T16:56:07.897-08:002011-01-15T16:56:07.897-08:00Concerning the lofty perch we seem to put some of ...Concerning the lofty perch we seem to put some of these surgeons on "Natural ability without education has more often attained to glory and virtue than education without natural ability." <br />Marcus Tullius CiceroAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-16487250304615342742011-01-13T15:09:30.562-08:002011-01-13T15:09:30.562-08:00P.O.D. actually stands for "Payable on Death&...P.O.D. actually stands for "Payable on Death" in business terms,,<br /><br />Pretty fitting for this topic I'd say.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-87842747510176288722011-01-13T14:10:40.039-08:002011-01-13T14:10:40.039-08:00I bet if you check the data on wasted implants, yo...I bet if you check the data on wasted implants, you will see the same trend. I also bet that in those revisions, they are removing all screws and putting in shiny new ones, whereas before, they would reuse the screws in the previous fusion mass. Do more fusions, use more screws per fusion and re-operate as often as possible. Is that triple dipping? I lost count.<br /><br />This is also a sign of what is coming. As physician pay goes down, the indications will continue to loosen and more operations will be done. Humans have an amazing ability to justify whatever it is they want, even if they are hurting people along the way.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-70501066300405597782011-01-13T13:39:16.290-08:002011-01-13T13:39:16.290-08:00POD Business Model Risks
1. PODS present an ethica...POD Business Model Risks<br />1. PODS present an ethical conflict of interest that will distort medical decision making.<br />2. PODS are anti-competitive.<br />3. PODS will most likely lead to higher implant costs and lower the quality of care in the healthcare system.<br />Example: A study of one hospital where a POD was implemented resulted in an increase in the number of fusions by 60% and the number of refusions increased by approximately 359%. The increase in refusions demands explanation. One possiblity is because the type of devices sold resulted in more failures. Another possibility is that the refusion surgeries were not needed. The sudden significant increase in refusions at this hospital is illustrative of the essential conflict of interest with PODS. This data raises serious questions on whether a POD poses an increased risk to patients, the patients, and payors. Something to think about.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-2660086355102132072011-01-13T09:31:18.553-08:002011-01-13T09:31:18.553-08:0012:25 is the best post yet. Like it or not, "...12:25 is the best post yet. Like it or not, "good" doc/salesperson aside, the industry heavily incentives more surgical procedures, with more implants. <br /><br />Got a back pain? Screw (heh, no pun intended!) drugs and intensive rehab! How about a fusion... It even sounds more sexy than rehab, so why not!? Several studies are out there that say intensive rehab is no better or worse for chronic back pain than a fusion. <br /><br />So why are fusion surgeries increasing?<br /><br />MONEY!!!!!! Heck, look at the majority of the recent posts. It's all about who makes money and why. After all, as long as insurers pay, who cares!?<br /><br />The more surgical volume a surgeon does (remember, except for a POD the surgeon doesn't technically pay for the implant), the more s/he gets paid. The more implants surgeons use, the more the salespeople get paid. Which, of course "keeps the lights on" so the marketing department can see the where the bottom line is to sign the consulting check for that same high volume surgeon...<br /><br />Viscous cycle, and certainly one that does not promote successful and meaningful outcomes, especially when compared to lower cost, less invasive alternatives. <br /><br />JMHO.... AnonymousAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-4547389646214202882011-01-13T09:30:16.067-08:002011-01-13T09:30:16.067-08:002011 will bring us continued falling prices and in...2011 will bring us continued falling prices and in my opinion, consolidation. As the dollars move from away from the manufactureres the smaller guys will be squeezed out because they cannot survive on the lower revenue. With that in mind look for buy-outs, mergers, and chapter 7's in our future.<br /><br />The Evil Empire (a.k.a., "MSD") and the other big boys will be in the driver's seat more and more. I predict that spine will experience the same cycle as hips & knees did over the last 15 years. The only hope the small guys have is POD's or hospital direct deals.<br /><br />...SpineSellerAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-1633671056041770662011-01-13T09:15:21.937-08:002011-01-13T09:15:21.937-08:00I am tired of the blind reverence that we have bee...I am tired of the blind reverence that we have been beaten into with regard to the surgeons we work with. Not all surgeons are smart...many are complete idiots. I have met people in many other walks of life that are much better rounded, better problem solvers, more creative and more insightful. Working in this industry for almost 15 years has made me skeptical towards physicians in general; their competence as well as their ethics. The general population that has been snowed into worshiping the work and opinions of physicians would be floored by the realities we see. Ironically, I am watching a news conference on TV right now, and Dr. Rhee from U of A Med Center is on camera in his scrub cap...which he will undoubdtely wear in the OR, in the ER, in the halls, in the bathroom, in the cafeteria, and probably store on the floor of his Beemer until he puts it on again. What a pro. <br /><br />There are brilliant surgeons in the field, and just as previous posters have mentioned, great talented reps. In every field, the cream (typically) rises to the top. <br /><br />Medicine, like academia has dirty little secrets that the insiders protect with all of their might. <br /><br />I have not problem with the best reps out-earning their customers...I not only think they deserve it, but I love that the surgeons resent it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-87160477074442302442011-01-13T05:27:42.169-08:002011-01-13T05:27:42.169-08:002:30 & 6:27 are spot on. Sales make the light...2:30 & 6:27 are spot on. Sales make the lights go on at every company. Our market is mature and not about products or companies anymore. Its about distribution. Sales is the key and the talent to bring in revenue is greatly valued by management.<br /><br />Its the same in every industry. Talent is compensated whether it is medicine, sales, broadcasting, finance, or sports. Those that produce results earn the reward for their skill.<br /><br />Same can be said for spinal surgery. The average spine surgeon makes $800,000, but the top talent brings in multiple millions. Many do so by building great referral patterns or market themselves successfully in their markets.<br /><br />A system in which competition is removed, i.e. a POD scenario, is an attack on capitalism. There is no competition. Why are these surgeons afraid of competition with their peers. Can't they build better practices to enhance their businesses? The problem with locking-up there hardware usage is a breeding ground for wrong-doing. Stick with what your good at - practicing medicine. Be a better competitor with your peers and let the commercial people compete for your business.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-18707543949554329402011-01-13T00:25:04.519-08:002011-01-13T00:25:04.519-08:00Love the thread!
I'll try to be as general a...Love the thread! <br /><br />I'll try to be as general as possible here.<br /><br />A major item that will ultimately be the demise of many spine companies is the lack of focus on patient outcomes. This day is coming for surgeons as well.<br /><br />Its short-sighted for a surgeon to give business to a company that makes little investment in procedural innovations or well-designed patient outcome studies. These companies provide no value to securing a future for the work many surgeons have left to do... and there is a LOT of work to be done.<br /><br />The last ones standing will be few, but will do well for many years. These will be the companies that provide surgeons, hospitals, and payors with REAL data to justify the high costs for their products and services. Surgeons will be held accountable for their outcomes too!<br /><br />Good news for sales reps and surgeons... if you're good, and you conduct business ethically, you'll land on your feet. <br /><br />If you "walked into something good," just know that the wave you're riding will hit the beach soon enough (it may help to have a good lawyer riding the same wave).Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-47959984404655808372011-01-12T20:34:26.602-08:002011-01-12T20:34:26.602-08:00Let us not forget, there is a big difference betwe...Let us not forget, there is a big difference between a Salesman and service rep.. IMO, a majority of spine reps are service reps., they haven't been around long enough, with 1 company, to know enough to make an impact. So, are you selling or just supporting ? A monkey can fill out a charge sheet and fill a tray. Selling is an art, just like medicine. Some are good, some are bad. I appreciate all the bad reps out there, makes me look that much better.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-35007846806358567972011-01-12T19:21:52.165-08:002011-01-12T19:21:52.165-08:00Amen Brother 6:27
Tell it like it is, He who make...Amen Brother 6:27<br /><br />Tell it like it is, He who makes a beast of himself gets rid of the pain of being a man.Musculoskeletal Manhttps://www.blogger.com/profile/14873819014357051373noreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-32309235933548898892011-01-12T18:27:00.905-08:002011-01-12T18:27:00.905-08:00To the defenders of the docs, if a doc is making l...To the defenders of the docs, if a doc is making less money than the rep, who's fault is that? If a doc is making less money than a rep, and their business acumen is that poor, is it the reps fault they don't know how to make money. Instead of taking the easy way out and doing a POD or taking kick backs, wouldn't you be better served to change your ways and figure out what the hell you are doing wrong. That's what profitable companies do, and business people of all types and industries. Those in business that can't figure that out go by the way side. <br /><br />Having worked side by side with industry experts who make a living helping surgeons manage their practice, even recently, the issue is not the lack of patients, reduction in reimbursements (in actuality, there has been little change), it's continuing to do the same thing and expecting a different result. The enemy to the surgeon is resistance to change; re. not being willing to recognize or accept the fact status quo is not going to work. If any think industry is not taking hits, not loosing revenue and reps are making more money, clean your glasses. It ain't true. <br /><br />Finally, in how many jobs can a person make mistake after mistake and still make $800K. Not in sales. Screw up once, your out ... forever. If your office closes their doors, while a bit inconvenient, are you ever worried you'll not find a job? Try in on the sales side. We take risk, serious financial risk. If you, doctor, decides your sister, brother, cousin, wife, husband, girl or boy friend should be your rep, does it change your financial status, threaten your job, threaten your way of life, one you have invested many years of your life in most cases. <br /><br />Believe it or not, there is a majority of people in our profession who take it seriously. Yes, we expect financial reward to build, grow and maintain a business ... you expect the same. But, I promise you, your risk is very, very low that it could all be gone with the stroke of a pen when a company is sold, a hospital agreement that aces you out is signed, a funny deal is done so a surgeon can make a little more "free money" is signed. <br /><br />A few years ago, a surgeon friend of mine thought he wanted to live the life of a sales rep for a week. We took a trip, a place no-one would know him and past him off as a new recruit. He made it three days. That was enough, he couldn't stand it. Couldn't stand how we had to put up with so much crap, lack of consideration by customers and potential customer, late nights, early mornings, hotel food and the total amount of information we have know just to be conversant. It was a normal couple of days. Never heard another bitch about how we are glorified order takers, stand in the back of the room flirting with the RNs, didn't earn anything. He got to see what's behind the curtain and it's not that pretty. <br /><br />So, doctors making the snide comments about what we do for the money we make, imagine yourself in our job having to put up with the kind of crap you spew every day. It's like being in heaven - NOT.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-81772556511255637502011-01-12T17:49:15.000-08:002011-01-12T17:49:15.000-08:002:25
Give us more to digest with more substance!2:25<br /><br />Give us more to digest with more substance!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-56429599445018656112011-01-12T14:30:12.398-08:002011-01-12T14:30:12.398-08:00@ 10:49
Actually, business does regard sales peop...@ 10:49<br /><br />Actually, business does regard sales people highly, which is why they're compensated so well. Their companies value the business that they bring, and they reward them accordingly. Luckily, industry realizes that the best rep will eventually earn business, regardless of product, so they pay to attract the top talent. It's unfortunate that you view salespeople in such a negative light, that's your preogative, but they are just working to support their families just like everyone else. No need to be jealous just because the market dictates that the best reps are handsomely compensated. It's just too bad for you that your disdain for them affects nobody but yourself... Sorry.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-1156016746445055972011-01-12T14:25:21.640-08:002011-01-12T14:25:21.640-08:002011:
Stryker, Medtronic, and all the organization...2011:<br />Stryker, Medtronic, and all the organizations who's strategy is founded in questionable "consultants" will lose market share at the same rate financial transparency increases (along with media attention).<br /><br />Synthes will continue to have loyal customers because of the AO.<br /><br />Biomet will grow conservatively based on the synergy with ortho's, the solid reps, and the likelihood that some of the pipeline will be released this year - not upper management.<br /><br />Globus goes public<br /><br />Zimmer has some great and knowledgeable reps, just depends on the quality of acquisitions.<br /><br />Lastly, less fusions will be approved and payers will decrease what they fork over for the ones that are approved. This will probably result in the gradual reduction of rep's commission percentage.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-84808448988719850972011-01-12T11:00:25.181-08:002011-01-12T11:00:25.181-08:00We must unite together. Spine surgeons were atta...We must unite together. Spine surgeons were attacked last week by Bloomberg and the next week an SAS advocacy group responds to their defense. RYOrtho does an we-basedinfomercial for the sleezy POD from CA recently and we do nothing. Crickets...<br /><br />We must form an advocacy group. A small membership fee goes a long way to aid the formation of a commercial advocacy group organization andl provide funding to challenge these dirty docs. If we bring heat in the press and politically these PODS will fail. <br /><br />There is an advocacy group in D.C.<br /><br />MEDICAL DEVICE MANUf,'ACTURERS ASSOCIA TION<br />MARK B. LEAHEY President& CEO<br />1350I Street,NW Suite540 202.354.7l74 Washington,DC 20005 fax 202.354.7176 www.medicaldevices.org mleahey@medicaldevices.org<br />InnovationTodayfor BetterHealthCareTomorrow'"<br /><br />TSB - help us if you can. If we disappear, I am afraid you will have to cow-toe to these bastards and become Robin Young's Cato Caitlin.<br /><br />Help us preserve the American Way of life!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-48078019719598423592011-01-12T10:55:38.522-08:002011-01-12T10:55:38.522-08:00All of you are missing the point on acquisitions. ...All of you are missing the point on acquisitions. Products need to be a part of any acquisition strategy. But in today's market, you better be invesing in talent. All these problems will pass and the companies that attract and pay for the best talent, exclusive of product will win. Zimmer will be standing tall precisely because of the fact that they failed to execute on two spine acquisitions and have fundamentally learned their lesson. The market size of spine is too big for them to ignore. Investments will continue, but it will be an acquisiton strategy based on great people and some products. Check out their recent Group President, COO or AVP hirers. They are building for the long term.Ruptured Discnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-91191492306635963722011-01-12T10:49:19.256-08:002011-01-12T10:49:19.256-08:00thank God for all the sales reps. Society has alw...thank God for all the sales reps. Society has always regarded and valued them highly. So vital.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-62556671174265998242011-01-12T10:26:26.187-08:002011-01-12T10:26:26.187-08:00I wish there was a way to short these PODs!
Look...I wish there was a way to short these PODs! <br />Look doc, you're smart, we all know that, but do you know how many engineers, salespeople, etc. Have said "the boss makes all the money and does nothing, I could run this business!". After which they all go on to miserably fail (as most businesses do). Just like you, they thought they could do it, that they were smarter, they couldn't lose.<br />Fact is, you're in an even worse position than 99% of business owners because you already have a job that keeps you very busy. Where will you find the time to outthink, outwork, outdo the other people trying to take you down?<br /><br />So with the odds very against you business wise, your reputation tarnished once your greed is exposed on 20/20 or WSJ, your constant worrying about legal action being taken against you ( even more than now), and your relationships ruined by f!$&ing anyone in the industry who has helped you...don't say I didn't warn you.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-126852961571725269.post-19500789986395690082011-01-12T09:12:32.815-08:002011-01-12T09:12:32.815-08:008:40
You are missing half of the equation. The va...8:40<br /><br />You are missing half of the equation. The value there brings into the OR is not what he is paid for (but it should be thereason a doc uses that rep). He is paid for the value he brings the company he represents. If a doc is calling him instead of any one of the masses selling these products, that is his value to the market. If you remember, docs don't pay us, companies do. The fact that the pay is "obscene" in your view is irrelevant because you don't have a role to play in the negotiation between a rep and a company. So as much as you don't like it, you have no control what a rep makes. You can only control IF he gets paid by using him or not. Don't let that be a determining factor in who you choose as a rep.Anonymousnoreply@blogger.com