Thursday, January 6, 2011
Spine Survey
Since TSB considers this the People's Blog Site, we thought that it would be interesting to get your take, rather than some analysts, as to whom will be the industry winners this year, and who will join the losing ranks? Is there any emerging hardware or software that will truly make a difference? Does anyone believe an IPO will be underwritten, or, will we go through another year of hearing non-sensical commentary about who is or isn't going public. Will Stem Cells become the New New Thing, or is it a lot of hype, as usual? Our bloggers want to know what you think?
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Not sure but I like the new softer look better than the red. I don't need to be seeing any more red:-)
ReplyDeleteStem cells should be promising but not sure that Trinity/Osteocell and ATECs Puregen are the answer. 1:400000 viable cells for cadaver and 1:250000 cells for adult living. Then again, who knows what puregen is anyway, nothing on their website and nothing in the press releases. Sounds like DBM with a minor boost. I don't think there are any implants out there that are truely unique, either. Aside from refinements in instruments and implant design. Get the FDA to pass a fenestrated screw for cement delivery and you've got a better screw, perhaps. A few disc replacement devices cleared and reimbursed and biologics to repair or rejuvinate the disc...then we may see some improvement.
ReplyDeleteMost of us went to NASS, didn't see much. OsteoMed ISP is interesting, not new but pretty novel and should address L5-S1 better than others. Went to Eurospine, thought there would be a novel idea or concept coming out of Europe, but nope, same ole stuff. Read most of the journals and am on a good number of news letters, thought we might see something interesting, again, nope, nothing for a long time.
ReplyDeleteThat being said, with the IDE process becoming increasing like pharma and 510K process in a total cluster not to mention and price caps, restricting hospital agreements, 3rd party looking for any excuse to deny, and PODs, it's not a big surprise. Even worthwhile study opportunities are sitting on the back burner or taken off the stove.
Those of us who have been around for a long time have experienced this before, certainly not to this extreme. Joints got a butt kicking several years ago forcing companies to finally look to developing something worthwhile vs. maintaining Xerox mentality. It kicked a lot of low hanging, rotting fruit off the tree. I think we can expect the same.
5:36 - rotten fruit? Elaborate please.
ReplyDeleteForget winners and losers, the new look is excellent.
ReplyDeletePlease define for me what a POD is? Someone in the know that can put a real definition out there. Do they die in 2011? I hear this term, see a little in my territory and I want to know more. Thanks.
ReplyDeleteFirst off, TSB, LOVE the new look, and I was a fan of the red also.
ReplyDeleteWinners and losers - Winners will be anything that intrinsically lowers product costs within the existing system. Streamlined distribution models, more efficient inventory management, products competing on the basis of being "the same, or just as good, but cheaper", etc. Losers will be anything trying to argue or continue to argue clinical benefit justifying increased costs. e.g. Kyphoplasty
POD's are Physician Owned Distributorships where a physician or group of physicians set up their own business to purchase implants and supplies directly from the manufacturers.
Proposed benefit - cuts out the distributor/rep and their associated costs as they just have a lower paying scrub tech provide product support and negotiate a lower price with the manufacturer that can be passed on to the hospital/insurer/patient (with a small profit for the business of course).
Problem people have with it - arguably creates a conflict of interest by having the previously 'independent' decision maker profit personally from their product selection, and often the cost savings to the hospital/insurer/patient are minimal with most or all of the distributor/rep margin actually going to the POD, not to the hospital.
More thoughts?
TSB would love to hear the conversation when the POD incubator from California approaches a surgeon group that either gets major royalties, has a consulting agreement, or, has major stock/equity holdings in a company, or has their girlfriend or child working for a specific company. POD's are not going away. Until someone challenges them legally, there will be no legal precedent unless Jerry Brown is your Attorney General. When hasn't California been different?
ReplyDeletePOD's exist in spine. This has been the impetus of many a "early-growth" stage companies whereas in times of financial difficulties, or looking to increase operating income they have rid themselves of their distributors, only to hire a scrub tech. It also saves time and money for many of these companies in not having to identify, hire, train and then deal with an independent distributor.
Lowering cost is the key. That is why we will continue to see companies export R&D and Manufacturing to Asian countries or bankrupt Ireland. Talk about how to increase surgeon adoption of your medical devices, just show them how they could make more money.
Knowing what a fenestrated screw is, please explain your rationale for using one. Are you implying that this would be beneficial for osteopenic bone? Or, is there another indication? If its intent is for osteopenic bone, the question I have is what happens when the need arises for a revision?
ReplyDeleteSo as cost is ALWAYS discussed ...but what about the dreaded Tort reform? There should be some realistic and common sense approaches to what is a honest mistake or lack of outcome versus true negligence. When will the USA wake up and make people live up to 2 simple words...."Personal Responsibility".... now that would reduce a cost!
ReplyDeleteI think a great change would be more changes regarding the last post regarding physician involvement with some of these companies. These surgeons could be involved in price fixing, where some companies are expected to enter a contract for a stand-lone ALIF at $4500 while the consultant based companies are forced down the hospitals throats by these docs @ $9500 per level. Think about it folks. Level the playing field. MSD has nothing more innovative than others.
ReplyDeleteTrans-1 just announced Humana will now reimburse for Axialif. Is this enough to save the butt-bolt, or is it too little, too late?
ReplyDeleteI think Axialif issues go way deeper than reimbursement. In addition to discectomy and pseudo issues a couple of their surgeon consultants have told me that the new executive management team is incompetent at best.
ReplyDeletemiss the Red....new earth tones are much too limp-wristed...
ReplyDeleteNuVasive will face tons of legal ramifications with their mid level management doing "whatever it takes" to get the business with Neurovision. I compete against NuVasive in the South, and I watch reps put on electrodes and act as though they are an expert on intraoperative neuromonitoring. They certainly might know more than the average rep, however, I cannot wait for someone to leave NuVasive and slap them with a lawsuit for forcing them to work in an unethical work enviroment. I have even talked to the rep, and he is super uncomfortable with the position that he is being put in. NuVa preaches a lay no hands, and then they do. This is a huge liability and will come to the surface in 2011 with all of the hospitals figuring out that this is a sham and not wanting the liability in their hospital. The other issue is how they actually touch the patient in the OR. This is a serious issue that I think is going to come to light this year.
ReplyDelete8:09 - Do you offer your own neuromonitoring equipment?
ReplyDeleteTSB.......waaay better than the red!
ReplyDeleteGlobus goes public in 2011. They have to.
ReplyDeleteEven if they are worth a couple bucks a share, it's better than nothing, and there's a lot of shareholders that need that now more than ever.
I agree with the Nuva lawsuit by an employee desiring millions of dollars for restoring the system. Anybody catch that 60 minutes episode about the whistleblower at GSK who got 97 million dollars......... wowzers. good golly miss molly.
Ulrich Medical has a fenestrated screw but can't promote it for screw augment.
ReplyDeleteWas in on a case with NuVa rep doing neuromonitoring. Surgeon touched the screw, then directly touched the nerve root and got the exact same reading.
I, too, have watched nuva reps in my area touch the patient, put in transcranial electrodes, needle electrodes, whatever products they offer from a neuromonitoring standpoint, those reps are putting them in/on the patient. What I don't understand is how in the world does nuva think that they are ultimately going to get away with this? The first disgruntled employee to leave that has documentation of his or her manager telling them to touch the patient and this company is toast. I am appalled that it has gone on as long as it has.
ReplyDeleteI am an ex-Nuva Manager who left for greener grass. I can tell you that Nuva has a very strict lay-no hands policy and if those reps or mid-mgrs were caught by someone from higher up then they would be fired immediately.
ReplyDeletebeen reported to higher ups before with no action taken
Delete@3:11 Amen! @6:55 - you may be on to something, I think. Perhaps hospitals should allow implant pricing guidance to only come from docs without affiliations, POD or otherwise. If a doc wants to use a product from a company that he's affiliated with, the price they are charging has to be reviewed by another of the purchasing department's choosing. That way you're welcome to invest in the POD, but another doc has to justify the price they charge.
ReplyDeleteHaving written that, there are two problems that make it useless in most situations. Either:
1. The relationships between the docs is too incestuous - partners, friends, etc, so one friend would just take care of the other.
2. There's practically no "unaffiliated" docs.
Oh well.
In the Northeast I have seen the NuVasive reps applying the electrodes for patient monitoring. BUT they weren't the only ones....Medtronic rep was doing it too....I sold spine hardware but did not have monitoring.
ReplyDelete8:09 Totally agree, about the electrodes. Even further, many risk management departments are starting to wake up to this, as well as the NUVA reps running the machine with no direct oversight. Major liability for the hospital. These hospitals are kicking them out for monitoring. Then what does NUVA have? A crappy retractor and a cage that destroys endplates. Good luck!
ReplyDeletePlace enough of surgeons on your payroll and anything is possible.
ReplyDelete@11:28 Yeah that appears to be the "official" position of NUVA on employees touching the patient. Clearly the unofficial position of NUVA is "what we don't know results in added profit for all of us." Turning a blind eye to a real problem will only work for so long. Can't wait for the big dogs to come knocking!!!
ReplyDeleteNuva bashing aside...
ReplyDeleteThere's going to be a ton of cash dumped into biologics. Of the seven varieties of BMPs, only two have industry derivatives. Beyond that, there are signs synthetic BMP (rh-PDGF-BB) may be efficacious in humans. Given the price point of Infuse, and the failure of OP-1, this market is ripe for competition. Not to mention, the implications of lower cost equivalents to payors, the least of which will soon be Obamacare.
On the acquisition side, I'm going to say Zimmer Spine goes on a buying binge to prop up a tarnished image and get back in the game.
It gets even better on the NUVA front! These reps go to their spine surgeons and "teach" them how to set up their own monitoring reading company and bill out for their own interpretations. The more saavy ones explain to the surgeons that the ins. companies will not reimburse them for their own reads of the monitoring data, but if they have another spine doc in town, or even a partner they can read for each other (after all its not like you really need to know how to interpret an evoked potential or EMG response)
ReplyDeleteIts a beautiful thing, just build a daisy chain of surgeons all reading for one another and laughing all the way to the bank!!
Great gig if you can get it, ooooooohhhhhh, did someone forget there are patients involved here???
zimmer will buy 2 of the following in 2011:
ReplyDeletealphatec, x spine, spineology, ldr, apatech, c spine.
It will be a little difficult to buy apatech.....maybe 2 of those companies are bought/sold next year but not to Z
ReplyDelete2:01
ReplyDeleteDid you mean Alpha Tec? It will be difficult to buy Apatech, since Baxter just bought them.
NuVa reps only place electrodes when they are forced to do so by lazy pre-op nursing staff. At least in my area, it doesn't happen very often, but it does happen. The agreements we have in place with hospitals clearly state that we are not responsible for placing the electrodes (hospitals are willing to agree to this because we are MUCH cheaper than traditional NM companies...we only charge for disposables typically billing for less than $1000 for an entire case), but most nurses put up a fight when asked to do it.
ReplyDeleteNot to worry though...NuVa has already negotiated a deal to buy one of the nations largest NM companies. The acquired company will provide licensed NM techs, and will in some cases, provide training/certification to existing NuVa reps interested in performing both roles.
For those voicing concern above re: Nuvasive,, they have & continue to face legal issues as it relates to Neurovision. In addition to the $60M decision against them for the name of the product, they have faced & continue to face numerous suits in which there have been nerve related injuries,, the reps are named in all of them as they are in the case at the time of the injury. Bottom line is that it is "no secret" as to what is going on w/ that product,, it's just a matter of time until it all blows up on them.
ReplyDeleteJust refering to 1:27's post. Apatech is the 5th company mentioned. I agree it will be "difficult" - precisely for the reason you mention.
ReplyDeleteWhile thinking about it, ISTO should have been added to the list.
I hope that the right people are reading the nuva comments. The purple machine has closed their eyes to the involvement that the reps have in the OR. It is a very serious problem and one that is coming to the forefront of many discussions. If I as a patient knew that a SALES rep was responsible for the placement and interpretation of my neurological function intraoperatively (I know nuva claims it's the surgeon, but we all know the truth) I would be plenty enough angry to take drastic measures. Standard of care, I think not.
ReplyDeleteHow many of you surgeons have put an XLIF retractor down the psoas while the monitoring tells you its safe, and once you crank the blades you find the nerve root?
ReplyDeleteAnyone......anyone?
WOW,, lots of NUVA bashing going on today,,
ReplyDeleteSo I might as well jump in too!! Anyone been in a case when the Neurovision machine simply fails to work and the screen goes blue or it freezes up?? I've seen that happen several times in my area w/ both their JJB units as well as the newer M5 machine. It's always amusing to see the reps panic and listen to them try and salvage things w/ the surgeon,,, pathetic.
Can't wait for things to come crashing down on them for the way that they've marketed that product.
SpineFrontier will make me a millionaire......
ReplyDeleteHow do you get rid of PODS? Distributors need to stop representing companies that are catering to PODS Choice and Spinal USA are the two most aggressive. Choice has relationships with Ascuelap and Alphashit but the funny thing is Choice tells surgeons that they make more money if they implant Choices Screw and cages. So stop selling products of all these corrupt companies, guaranteed you won’t get a reach around in the log run.
ReplyDeleteANON 3:09 said:
ReplyDeleteSpineFrontier will make me a millionaire......
Actually laughed out loud at that one.
@3:22--- Can't a girl dream big?
ReplyDeleteWow, sounds like some jealous reps in here who lost business to Nuva. I'm not going to disagree with anyone in regard to the fact that surgeons should be the ones placing the electrodes on patients. However I will say as a former spine rep I would rather have a trained rep placing those electrodes than many of the nurses out their. Some of the reps in the field are very intelligent, have very high skill sets and want to do things correctly as their ass is on the line if things don't work. Many of the nurses I see today are more concerned with getting the room set up than taking the time to place the electrodes in the correct spot.
ReplyDeleteSpineFrontier..........a million pesos maybe
ReplyDelete@2:58pm
ReplyDeleteNuVa's Neurovision (be it JJB or M5) is software driven just like the systems used by traditional NM companies. Anything that is software driven (computers, phones, automobiles, NEUROMONITORING SYSTEMS, etc...) has the potential to malfunction, and Neurovision is no different. I have seen traditional NM companies have severe difficulties with their NM systems as well. Software glitches are a fact of life. Nothing is perfect.
With that said, I can tell you that I always have a back-up system on hand just in case. Sure, there are some reps who do not take such precautions, but most do...especially the ones that enjoy having a job.
Neuromonitoring which is supposedly "physician interpreted" is a huge liability to patients. When the stupid machine beeps, what happens? The doc looks at the Medtronic or Nuvasive reps and and asks if everything is OK. What is the motivation of the rep? Since they don't really know if everything is OK, they say, "I think its all fine, just some feedback or electrical noise". Possibly the best feature of a 3rd party neuromonitoring company is that the implant rep is not running and interpreting for the doc. This is a really danger to patients, particularly in an XLIF, DLIF procedure where the root is in eminent danger.
ReplyDeleteEven if POD's aren't going away and their purported benefit is a lower pricing. What happens a year down the road when the hospital would normally have called the "Spinal Pricing Program" meeting. In ordinary market conditions, they would squeeze the vendors as we are all experiencing now. But can they really do that with the surgeons who bring patients into their hospital. It is a twisted world when the guy making the product decision is also providing the product while the hospital pays for it in return for the patient volume. Wouldn't we all like to be the salesman and the customer with someone else paying for what we bought (and sold). Its like a stand up comedy routine. I'm looking in the mirror making a sales presentation to myself and the guy in the mirror says "Heck Yeah, I'll take 3 of those suckers" and then the guy in the mirror looks over to another guy with his hat in his hand who has to pay for them. Thats a good gig if you can get it.
ReplyDeleteI may be naive, but I don't think POD's will be around for the long haul. Some arrogant surgeon will threaten to take his patients to another hospital if his facility squeezes him on price and then we will have some precedent from the urologists that were convicted for doing the same with the lithotripter.
4:15,, Sounds like Alex has you brained washed just like all the other droves of worker bees,, uhhhh, "Cheetahs" at that company. Don't kid yourself,, you could have 15 machines there as back up, it doesn't matter. The reality is that there are plenty, PLENTY of cases across the country where Neurovision was used and a legal battle is now unfolding,, sadly, you simply are unaware of these because Hannon, Spangler, et al are cleaning up the mess behind the scenes.
ReplyDeleteContinue to live in your world of denial and as for those that "enjoy having a job",, just how many of them continue to prep patients in their accounts?
5:07 What are those ratios you are quoting? I don't think you are informed about either of the products you mentioned. Both products guarantee a certain number of cells, one is cadaver based and does not guarantee viability or homogeneity of cells. The other is from live donors with fewer cells, but guaranteed viable and homogenous (for a short shelf life).
ReplyDeleteStem cells may change the market somewhat, but it will take studies and more reasonable pricing. Currently, you can't be sure if they will work or not since there is little data and they can be as much as Infuse. We do know that they will not cause the complications that can occur with Infuse such as inflammation and bone overgrowth (cells can turn off with the proper signal, proteins cannot)
@4:34pm
ReplyDeleteYes, you are right. There are "plenty, PLENTY of cases across the country where Neurovision was used". What is your point?
With the pure hatred that you clearly have for NuVasive (or is it Neurovision that you hate? Probably both, right?), sounds to me that you are the one that is brainwashed. My post (4:15pm) simply stated that Neurovision can occasionally malfunction and if it does, I have a back-up system on standby. How can you argue with that statement?
And for those of you that are making the ludacris statements about Neurovision being dangerous to use in an XLIF; either you don't have a sufficient understanding of the related anatomy and/or the XLIF procedure OR you are flat-out crazy. XLIF would not be possible without Neurovision...especially not at the L4-L5 level. The location of the plexus is highly unpredictable at this level. I am very interested to know how the traditional NM systems help a surgeon locate and avoid these nerves. Can anybody explain that to me?
@512
ReplyDeleteHow new are you to spine? Is Nuvasive your first job in the spine field??
First, re-read my previous message,, What I said was that Neurovision has been used in a number of cases WHERE A LEGAL BATTLE IS NOW UNFOLDING (due to a post op neurologic complication).
2nd,, There are just as many 4-5 cases aborted WITH Neurovision as there are completed, if not more. As far as your statement that "XLIF would not be possbile w/ out Neurovision"; THAT is the actually most ludacris statement on this board. Why do you think every Tom, Dick & Harry company now has a lateral system?? BECAUSE YOU DON'T NEED NEUROVISION TO DO THE SURGERY GENIUS; you can use any system out there.
It's called MARKETING,, that's all it is,,
As for the company & the product, I do not have a hatred for either,, I simply chuckle at reps such as yourself who do nothing more than spew the company line because you don't know any better.
The takeaway is this,, Nuvasive has placed far too much responsibility/ liability on reps w/ this product,, all to the detriment of the patient in the end.
5:34pm, I have been in the spine biz for over 5 years (first w/ a legacy and now w/ NuVasive), and I sold hips/knees before that. Thanks for asking.
ReplyDeleteFirst, I have re-read your post, and that is not what you said.
Second, you are wrong about being able to use any system out there. Sure, most companies are coming out with lateral systems, but how many of them are actually being used (excluding the "design" surgeons who helped "develop" them)? One of Globus' top consultants for LLIF still uses XLIF on all L4-L5 cases.
By the way, I have never once seen an L4-L5 XLIF case that was aborted, and I have seen hundreds. What are you talking about? Do you have a picture of a cheetah hanging on your dart board at home? Do you hate the color purple? Is there a traumatic event from your childhood that might have planted this seed of hatred for all things NuVasive?
5:34pm L4-L5 XLIF's?? Hundreds?? Your surgeons must be part of a POD in wheelchairs.
ReplyDelete2011 industry thoughts:
ReplyDeleteBiologics increase/opportunity
Hardwares growth in volume not pricing
IPO Globus maybe
Acquisitions wait till Q1 results public
New technology show me what you got
TSB like red more
Litigation Globus turning tricks on Penn Ave.
Winners; market share Stryker
Losers; sadly all of us
I was in a case with a NUVA rep who put his paw on the patients hip while they were marking their spots for no other reason than the fact that I was watching. It was as though he just had an "I'm a doctor boner moment"
ReplyDeleteNothing in all the world is more dangerous than sincere ignorance and conscientious stupidity.
ReplyDelete- Dr. Martin Luther King Jr.
oooh! A nice little joust going on. Well played sirs (or madams). Do keep going... Don't let us interrupt you...
ReplyDeleteOkay, sorry, that last comment (mine) seems a little out of place. Didn't refresh my web page and a few have been posted since the 6:46 it was meant to follow. Just mentally put it back there please.
ReplyDeleteDo 4-5 lateral procedures all the time with outside monitoring, no issues at all. Patients do great, you have drank the nuva koolaid my friend.
ReplyDeleteAgree w/ 5:48,, I work for a legacy company and do quite a few lateral procedures/ month in my area. Traditional monitoring works great & is never an issue,, in fact several of my surgeons have said that they'd rather work a little slower & wait for the responses from the tech in the room than put their trust in Neurovision.
ReplyDeleteMost agree that Neurovision has simply been marketed very well as Nuvasive has had to "hang their hat" on the technoogy in order to sell XLIF.
Bottom line is that as implant prices continue to drop & the competition grows stiffer for NUVA, they'll either find themselves giving away this technology at no charge in cases moving forward or be on the outside looking in once they're thrown out of accounts which has already occurred in 2 of my hospitals.
Keep drinking the purple juice my friend,, The Russian Bear will soon become the "Jim Jones" of the spine industry.
Can anyone answer this,, If Neurovision works so well, and you can't do an L4-5 lateral case w/ out it,,, Then why are there so many related post op issues when it's used??
ReplyDeleteI've talked to a number of surgeons who were "talked into" doing a tough 4-5, only to have a patient suffer from quad weakness, a foot drop, thigh pain/ numbness or any number of related issues?? How many Nuvasive reps actually understand EMG monitoring, let alone the MEP or the SSEP applications that they trying to roll out??
It seems that they've done themselves more harm than good in several of my accounts.
6:46 - Five years in spine does not make you a Viking. Keep your ears open and keep learning from the Docs you work with.
ReplyDeleteBest of luck to you.
Really? 'ludacris'? ludacris raps, ludicrous is giving any weight to the comments of these dopes.
ReplyDeletehoked on fonics woked for me
ReplyDelete8:49,, Did it? Perhaps you should ask for a refund as it's Hooked on PHONICS.
ReplyDeleteApparently you can't spell or read.
The problem with all of this is that the NuVasive reps have been trained and brain washed to think that Neurovision is the only way. They serioulsy think that. So you can't really have this conversation with them because they really really believe that they have the only solution. I am a former NuVasive rep and believed it too. Until I went into my first lateral procedure using outside monitoring, we stimulated every step, we had directionality, everyhing that NuVasive could do, we did, AND we got to run SSEP's AND we got to run MEP's AND we had someone in the room whos entire responsibilty was to monitor the patient's neurological funtion. And guess what, they were trained to do it. And guess what, we have now done over 100 of these, tons at 4-5, and the patients are doing great. We had one with quad weakness that resolved in 3-4 weeks at 4-5 were we were getting very low readings from the monitoring. I can say these are far better results that anything I ever got with NuVa. So yes, can NuVasive do laterals, sure. The problem isn't necessarly with the machine. It is with the placement of the electrodes. In most cases the NuVa rep is placing the electrodes and they have very limited training on this because they aren't "suppose" to touch the patient. So the Neurovision is actually doing it's job, working intraoperatively, however, the problem lies in the communication with anesthia, the specifics of the patients health (diabetic etc.) and many other variables that come in to play when monitoring a patient. The NuVa reps as well as the surgeons are not taking these variables into consideration, and outside companies are. Can other companies do them to, sure. Are they both safe, I believe so. I left NuVasive for a better opportunity in spine, however, I enjoyed my time there and do think that they have a unique culture. The problem with NuVasive which will ultimately lead to their demise, is there arrogance. I have never ever worked with a more arrogant group of upper managment and it trickles down to the sales reps, hence, the guy on here posting about not being able to do laterals without Neurovision. He has been through the NuVasive training and folks, he really believes it.
ReplyDeleteI'll try to steer this back on topic . . . NUVA is a great company and there are obviously a lot of "haters" but their footprint still pales in comparison to MDT and MDT reps are more egregious in their use of neuromonitoring and ultra aggressive reps pushing O-Arm, InFuse, etc.
ReplyDeleteGlobus > put up or shut up time for the IPO. Lots of docs who invested early on are itching to cash out. After that we'll see how real that sales number is. Globus will soon find out that disclosure is a real bitch.
Zimmer > Sooner or later this year the board will get tired of Dvorak's act. Regarding their Spine fantasy ... nothing innovative, no pipeline, horrible acquisitions, terrible talent management, "below average" at best sales force. When Dvorak is put under the gun or replaced, Zimmer Spine will be spun off or sold off quickly. I'm an investor ZMH . . . During the first analyst call of 2010, Dvorak stated flat sales for Spine with an uptick in Q4 2010. We'll see in a few weeks but their sales numbers are trending to an "outside Top 10" player in 18 months.
MDT > FY2010 they had $2.6B in hardware sales ... another $800M in biologics .... ladies and gents you can combine Synthes and Depuy sales and you'd still have to x2 to get to that MDT hardware only number.
PODS > only getting stronger. Until someone is made an example of the surgeons are going to cut out the sales rep. Only companies with complete product offerings will be able to survive.
Styrker > quietly getting stronger ... when will they pull the trigger on another acquistion?
Depuy > J&J has a ton of cash . . . will they pick off a Biomet or Zimmer?
Biomet > spiraling out of control ... old products ... ineffective leadership ... I thought the PE company would have broken that up and sold/spun off non-core companies. What are they waiting for?
~ An extraordinary amount of arrogance is present in any claim of having been the first in inventing something. ~
ReplyDeleteBenoit Mandelbrot
Does anyone else feel that Seaspine is an acquistion target in 2011? What happened on the Integra offer? I might need to pick up a competitive line.
ReplyDeletePrediction for 2011:
ReplyDelete- The D.O.J. will make a statement in spine, much the way it did in joints several years ago.
Are there anymore Docs out there willing to rain on the NuVasive neuromonitoring parade? Inquiring minds want to know.
ReplyDeleteSo, lots of stuff about NuVasive, speculation on IPOs, but nothing on new technology, new products, a new technique. That's a shame.
ReplyDeleteZimmer making an buy? ... doubt that. They know they screwed the pooch with the Abbott Spine deal, the integration (if you can actually call it that) was a total bust. Their house is in such a turmoil, though they have the cash, they couldn't integrate with a $5 hooker. Lots of nice folks there, but most are so frustrated, and distrustful the division is almost comatose. It's a shame.
For PODs, have a surgeon friend, senior in years, internationally known and respected in many circles who doing his best to stay in practice and in business. He's always been commercial, but legit and never made a commercial decision over patient care that I'm aware. He's the last person in the world I would suspect to do a POD. But, then he showed me his balance sheet before, and six months after. First half of the year only half the months showed a positive operating margin. Second half, all profitable, even able to hire some extra help in the office. Even if they shut him down in a year or two, it's given some insurance to keep the doors open a little longer. This is only one story and the only I know positive about PODs. All the others are about money grubbing greed and arrogance.
what ever happened to disc regeneration technology?
ReplyDeleteMM: Would it be so terrible to force anyone who cares enough to post to first log in so we can put an end to the overly-used Anonymous?
ReplyDeleteEveryone (AKA: the lazy/paranoid): Creating a single user ID will not magically reveal your identity.
Agree with most of the posts here esp. about Zimmer Spine. I'm ex- Abbott Spine and was there for few months after acquisition. 'Terrible' is the only word that comes to my mind...the way it was done. Looks like they still have not improved and management does not seem to have that aptitude and skills to run the show. Some nice and talented people there...that's for sure. Alas...it's such a shame!
ReplyDeleteWhat's with the birds?
ReplyDelete... turn, turn, turn...
ReplyDelete7:51, kickoff isn't until 4:30. Please ask again later.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteEvery non-maneuver or single acquisiiton makes medtronic happy as nothing is happening and they stay in the same position. zimmer spine is completely neutered. they wont make a move until someone else does. zimmer is lucky that their 1st acquisition may be the best since every one else's 1st takeover will suck. Instead of going minimally invasive i bet the first moves we see this year are revenue based.... meaning acquisitions will be me-too fusion based. It will be funny to watch someone buy k2m, seaspine, spinal elements, globus, or alphatec and watch their revenues halve in 5 months or less
ReplyDeletewhats funny to me is that in today's world no single M&A will be enough. Companies need to buy 4 technologies at once to have any chance to benefit. Management teams will realize this in about 12 months when their jobs are on the line. In 12 months management teams of the top 10 companies will have to do something to keep their jobs.
SpineGuy - complete and total waste of time and energy to log in. What's the point? And why people join this blog as a member is beyond me.
ReplyDelete@1:12 K2M was already bought by a private equity firm,
ReplyDeleteagree on the others
The aforementioned private equity firm bought K2M with the intentions of flipping it for a profit a year or two down the road. Word on the street is that the " flipmaster" himself, Jeffrey Lewis from Bravo's Flipping Out has agreed to take the project, but only on the condition that they remove that silly demo video from the company's website immediately.
ReplyDelete"Stop it Jiff..."
ReplyDelete~Zuella
I don't have to much to add, I really just wanted to log in under my new "handle".
ReplyDeleteMy feeling is that this COULD be a big year for the Big 3. Synthes has the "Matrix" coming, MDT has Solera and J&J has better have a few good things in the pipeline. These three companies have been pretty quiet for a while now, and I would imagine they're all looking to make a big statement in this wild market.
ReplyDeleteMany other companies would like to as well, but simply don't have the cash (cough, Nuvasive, cough).
Should be interesting...
Keep your eyes on Baxano. A nice niche company w/ a novel approach to a facet preserving decompression. I've seen it at a few shows and I've also seen it used in several cases during fusions w/ a couple of my top docs. All seem to like it and says that it works quite well.
ReplyDeleteBaxano, a ~$3,500 non reimbursable charge fir a decompression? Yes it works, bu affordable?
ReplyDeleteBBQ Sauce is the future
ReplyDelete6:26 LMAO!!!!!
ReplyDelete@12:05 right on the money. A $3500 charge for anything that doesn't have a carveout and can be done without is a difficult sell for any procedure.
ReplyDelete12:05 & 1:52 Same thing was said about Kyphoplasty circa 2002 when not a single insurer would pay for it at the time,,seemed to work out pretty well in the end for Kyphon I believe,, Vertebroplasty was certainly a viable option at the time, yet surgeons saw the benefit of the former and chose to stick w/ it. It took nearly 3 1/2 yrs before that procedure was recognized and had it's own code.
ReplyDeleteWho knows what the future holds? Especially w/ so many insurers looking to reduce the # of fusions being performed & paid for moving forward.
@2:03 that was then, and this is now. If I'm not mistaken, back in those days the balloon was billed separately, and with a markup no less, thus making the use of a balloon a money maker for the hospital. For most common procedures, e.g. decompressions and fusions, those days are gone and the global fee has to cover everything the doc wants to use.
ReplyDeleteJust got a blast mail from ISASS' Dr. Errico on how these articles recently written about spine surgeons greed is "sensationalistic"--he gives a compelling argument for rates of successful outcomes --but, funny how he doesn't mention anything about the "money": http://www.isass.org/public_policy/response_to_bloomberg.html
ReplyDeleteI predict- Smith & Nephew turns down a $11 billion buyout offer from J&J.
ReplyDeletehttp://www.medcitynews.com/2011/01/smith-nephew-turns-down-11-billion-buyout-offer-from-jj/
Hello McFly
I predict Globus will fool everyone. Everyone.
ReplyDeleteThey are actually developing a time machine out of a jet boat to launch on the Schuylkill River. And you thought they cared about spine implants...
I can't believe there are over 90 hits on this blog. Nice job losers.
Sincerely,
Life moves us
It's not a jet boat they're working on! Get it straight, it's a robotic dolphin! BTW, after reading thru all of this, we may all need some Adderall for the attention deficit disorder. Will this post crack 100 comments? MSM, it's a milestone! Also, does anyone know anything about stem cells besides the ATEC and NUVA guys (yeah right!)? Damn, just droppped my sandwich in the shower!
ReplyDeleteI wish UGA was in the bowl tonight. OHH well. Here's hoping the Falcons kick some butt this weekend.
ReplyDeleteAnyone interested in using Facet Screws? I am trying to achieve 1 million pesos.
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ReplyDeleteComparing Kyphon to Baxano is ridiculous. One product was completely new to spine surgeons and the other product is a new toy to add money and time onto an existing procedure. End Result....the same. It may have worked years ago but not in this day. Regarding POD's...it is unethical and give me one example where a hospital saved money. When your patients find out that you are getting paid to put in one companies products it will not matter if it is legal or not....the perception will cost you your patients...esp when the competitor doc across the street finds out. Do not work with a company that will allow products sold under a POD. It is a group of salespeople who couldn't find success in anything else so they had to pay the surgeon to use the product. SURGEONS BEWARE!!! This will come back to bite you!
ReplyDeleteAre you all really so arrogant yourselves to think that you all deserve the 10-20 percent commission on these over priced products? Half the sales reps I know are athletic trainers or former cheerleaders with boob jobs and do you really think you are 'earning' 300, 500, 700k a year? in your territories. The surgeons are the mules and you've been riding them all they way to the bank.
ReplyDeleteThey are tired of being pimped by you jackholes and tired of you making more than they do in some cases, when you take none of the risk.
Surgeons are the ones doing all the work, taking all the risk, invested all the years of training and have the patient relationships they've cultivated.
Surgeons will choose comparable quality products (we all know that these products are more or less the same, c'mon). The government and hospitals will like it, b/c it drives costs down. Surgeons like it b/c the money goes to the people who do all the work, like it should, ie them.
So for all you greedy ingrateful entitled 'reps' ...sorry to break it to you...don't get too comfortable with your current lifestyle. PODS/SODS are here and growing....and your salaries will be reduced to what reasonable levels they should be at. Your days of distributors gouging hospitals for $4000 PEEK that cost $168 including overhead, are coming to an end. It's time for you to downsize.
"patient relationships they've cultivated"
ReplyDeleteLaughable!!
11:19 Not sure where you live or work, but your surgeons must have been living under rocks if you're in fact stating that "kyphoplasty was completely new to spine surgeons",, I guess injecting cement into a vertebral body was a completely new & revolutionary idea for them although vertebral augmentation had been around for years & years via far less costly alternatives??
ReplyDeleteYikes,, I guess your docs are still in awe of & using Steffe plates & BAK cages as well and aren't aware of the "newer" advances in spine?
11:46 - Who are you to say what any person deserves to make on commission? How does it make you feel when someone tells you what you should make?
ReplyDeleteAdditionally, where do you get your information from - I can assure you that most reps don't even come close to touching 300K, let alone more.
None of my surgeons would ever refer to me as a "jackhole" or cheerleader.
I'll agree that some of the tech we sell has become commoditized. But where do you get these numbers from - $168 including overhead? Please define "overhead." Are you including FDA costs, packing, shipping, etc. Or is that simply a number you heard from the surgeon buddy who signed you up?
No one is pretending that we sell products at 10% over cost. Reps aren't paid to determine pricing - they are paid to sell. And if they fail to do so, they must find another job. It's fair.
Don't pretend to fully understand our lives, and we won't pretend to fully understand yours.
I pray you never show up in my territory.
11:46 - The average spine surgeon makes $806,000 per year delivering 45% to 75% functional improvement for patients. I hate to break it to you, but do you deserve to make that kind of revenue for such poor results? Even public school teachers have a higher success rate than you. If I delivered equipment to you 45%-75% of the time I'd be unemployed. Instead, I deliver it to you 100% of the time and it still isn't good enough to overcome your selfish greed.
ReplyDeleteRegarding the cheerleaders with the boob jobs. They are there because many of you -surgeons - are weak-minded when it comes to their little brains. You want them in the O.R. and thats why you have them. Once your entitled-nerd asses achieve a certain level of success, you know when the God-syndrome overtakes you, then nothing is good enough for you. I bet you actually think she wants you for your charm and charisma.
Companies used to provide top-quality trained reps - i.e. Stuart Medical, Acromed, & Danek to name a few, but after you greedy slimballs started taking sham consulting and royalty deals, payola, trips, and now PODS, this priority has taken a back seat to your avarice.
It comes down to ethics and morals. I bet you are one of those surgeons on your second, third, or fourth wife. Your ethics and morals are warped and twisted. That is why you see no problem with PODS - it suits your greedy purpose. Your "patient relationships" and "reps" deserve better than you - your a dirtball!
11:46, easy big guy, pod's are as unethical as you can get, and you calling the rep greedy?? huh, thats the pot calling the kettle black wouldnt you say. Just wait until companies start coming under the pod's pricing at hospitals, then lets see how happy hospitals and govts are with pod's.
ReplyDeleteWhat does SODS stand for? I know what PODS means
ReplyDeletePOD's,, Can you say "House of Cards"??
ReplyDeletewhat do people this about orthofix?
ReplyDeleteI don't understand why the NYT has not touched the topic of POD's. Maybe they need to be enlightened. LifeSpine, Spinal Elements (also the has world monopoly on PEEK), and Alphatec are the companies I know of that are supplying the POD's.
ReplyDelete12:12. Not sure if you can read...but the blog from 11:19 stated that Kyphoplasty was new to SPINE Surgeons. If you were around back then it was only a handful of radiologists putting cement in the spine without the balloon...and it was mostly performed in Europe with questionable results. I think the point was that it is a different time in spine and hospitals and insurance companies are not going to pay extra for a procedure that is already done successfully. But good luck if you are trying to sell it!
ReplyDelete4:43: What a stupid comment. Everyone knows time machines are built out of Delorians.
ReplyDeletespinegrrrl, UGA sucks and will never see a BCS championship game so long as their road there leads through Jackonsville. Go Gators!
ReplyDelete11:46
ReplyDeleteThe 300-700K income numbers are very inflaited. Most reps in this business are making between 100-200K which is a great living. Without this premium in income there would be no reason for most of the talanted people in this industry to stay around. Reps take crap from the hospitals, office staff and from a good amount of the doctors. We start work early and work as late as you need us to and then leave your case to go set up for the next day. We make the choice to do what we do and I don't think we are looking for pittty but don't act like we are a group of lazy and worthless people that are getting rich off of your hard work. Myself as well as my colleagues respect the hard work and effort that is required to become a spine surgeon and are well aware that most of us have not put in the 15+ years of education required to get where you are. Sales jobs in general have always been a place where people can make 50k-$1,000,000 a year and there is no reason for you to be upset about another persons success. I don't see many spine surgeons quitting their jobs to become spine reps, and until that happens I think it's best that surgeons continue to play their role and we play ours.
MM, this thread has been awesome! Seriously though on the topic of POD's. If these companies are so great, ethical and legal. Why have the big four or five not gone to this model? One would think that if this is so great depuy, mdt, stryker, nuva et al would take all their surgeons and make them a pod?
ReplyDeleteSpineologey also sells to POD's, for anyone out there also looking for a Non FDA approved device for fusions and fx. That will make your POD even more interesting for the lawyers.
ReplyDeletereally guys? some of us are overpaid don't you think. there are guys in my distributorship clearing 7 figures. They don't drive their fancy cars to the hospital b/c they are embarrassed and don't want the docs to see how much they make. Spine surgeons make a lot in general, but not all orthos are making a killing.
ReplyDeleteIt's just downright wrong and unethical for a rep to make more than a surgeon does for a case. Setting up, pull sheets, cleaning up, transporting/courrier whatever. You guys know good and well we don't want the docs to know what we get paid on their cases. Its shameful.
Its not our fault though. It's the distributorship. They overcharge for these products and we know it. Grow up. You all are an embarrassment to our profession.
So while some surgeons are doing PODS for the money, others are doing it in cooperation with the hospital. Helps hospitals keep money for services. My wife's cousin is such a doc. Very ethical and conscientious.
The truth is, distributors overcharge, we are overpaid give our level of training and education and many docs are greedy too. Market forces will drive prices down. Lets just be honest about this and move on.
@11:45/3:28
ReplyDeleteThe "distributorship" that you supposedley work for would be the exception (not the rule!!) if there are multiple reps pulling in 7 figure salaries. As 2:17 already stated, 90% of all reps in this biz earn $100k-200k per year, and you know it!
Why don't you just come out from behind your veil of secrecy and tells us all what you have to gain here?
Blaming the Distributor is a joke! As a distributor I have worked diligently to earn the respect of my surgeon customers, and have done so with great success. I simply work smarter and harder than my competition. My surgeons know of, and believe in the value I have added.
ReplyDeletelet's be honest, the villians here are the manufacturers, who 99% of the time are run by executives that don't know their own industry. I have had numerous manufacturers turn down capitated pricing in my accounts, then I have to listen to some dumbass VP of Sales or RSD tell me my numbers need to improve.
The truth is that hospital profits and surgeon reimbursements have been steadily decreasing over the last 10 years, while implant pricing has increased 10 fold. This is a trend that must stop.
As for you 3:28, your distributor should be embarrassed, you're a disgrace!
3:28 here
ReplyDeleteI wake up every morning and look in the mirror and tell my self "Jack Maertens you are a great rep"
Hey 11:46 Doc,
ReplyDeleteFirst things first, as reps, we don't ride on your backs. There is a reason that you pick the reps that you use out of the 200+ companies out there. Your usage doesn't determine what they make, that is a market driven number that is decided by the companies that are desperate for your business. If they think they can pay 5%, that is what they will do. If they feel they have to pay 30%, that is what they will do. You seem like one of these pricks that would fire a great rep because you think he makes too much and that you have control over what he makes. The thing your arrogant ass doesn't realize, is that the next guy in line that you use makes just as much on your cases or maybe more, he's just not as good as the guy you fired and may end up putting you or your patient in a bad situation. What you have is a bad case of greed and jealousy. The amount of time you spent in school has exactly zero to do with what you should earn. For every prick spine surgeon out there making a $1M per year, there are a dozen regular Joes with a high school doploma or an undergrad degree that are making more. Yes you are smarter than that guy, and the reps that service you, but you are not entitled to make a nickel more than anybody. You signed up for 15 years of school and the risk and the hours, so don't act like you got a raw deal. Grow up and realize that the market needs good reps, maybe more than it needs good spine surgeons, and that alone will dictate who makes more or less. If we have it so good, apply for a job and quit whining. You suck.
@11:45/3:28
ReplyDeleteFirst, after reading your posts, I don't think you're doc, but an analyst or similar upset with rep salaries.
Second, as 5:18 points out, the law of supply and demand determines the prices for both implants and reps. One, but not the only, problem with our system is that surgeons have traditionally not been particularly helpful to their hospitals in trying to keep/push implant prices down, preferring to take the side of the company/reps who give the surgeon various perks. That's changing with gainsharing and surgeon owned hospitals, where surgeons now have a financial incentive to keep prices down. But POD's don't give the surgeon any incentive to keep prices down, rather just to use the product that lines their pockets. It's unethical, and undoubtedly will be found illegal in the long run.
3:28 is a nepotist of surgeon, or a surgeon, in search of a POD or involved in setting one up with a relative who is a surgeon. Your comments are outrageous.
ReplyDeleteSurgeons are supposed to provide care to patients. But surgeons seem to think patients exist to make them rich. Shame on you 11:46 and 3:28.
It isn't easy being a rep in this business. It takes a year to two-years just to build relationships, unless of course you are plugged into relationships built by somebody else. Usually a rep starves trying to get to this point - a 1099 working on straight commission with expenses, office lunches to feed your fat asses just so we can meet you, and so on.. Then when a rep finally establishes themselves they lose customers to a consulting agreements, a surgeon girlfriend, a son, conflict of interest, or even worse - the company they work for gets acquired. There is risk and much instability.
It takes a great deal of emotional IQ, persistence, and drive to succeed in this industry. It isn't easy dealing with surgeons and clinicians and developing the intestinal fortitude to succeed.
Can we get something straight here. I keep hearing about dwindling reimbursements, yet the average income for spinal specialists has sky-rocketed the last ten years as have the number of procedures. What a bunch of shit. Don't you guys read the WALL St Journal - look what these surgeons are making - VACCARO, RIEW, WANG, LOUISVILLE 5, MN MAFIA (PINTO, TRANSFELD, DENIS< PERRA), ZIGLER, ZDEBLICK, POLLY, LIEBERMAN, CARRAGGEE to name a few. These dudes are making a killing, so give me a break already. Sadly, these guys are all power-brokers at the leading fellowship programs that control NASS, CSRS, IMAST. These are the guys that surgeons look up to in this industry. My heroes.
LIES, LIES, & MORE LIES!
There needs to be a like, dislike button... like on Facebook. I LOVE some of these comments and would merely like to 'second the motion' on some of them.
ReplyDeleteOnly time will tell. Either way, with or without PODs or SODs, the Reps salaries will be coming down. Pro athletes make ridiculous money b/c the market dictates it. It's still obscene. Reps make ridiculous money considering what value they add (half the cases that are done they are not even present. inventory is on the shelf and they are off-site. passive commissions. nice m.o. - good for them)...but it's still obscene. Surgeons reimbursements have been declining for 20 years, not b/c they are unethical or bad docs, but because the market forces dictate it. Now the spotlight will be turned on distributors and reps. It was just a matter of time. Just be glad you lived on the gravy train as long as you did. Docs are getting smarter at business and making money for the value of the services they provide. That's their advantage. Multiple sources of opportunity. Not fair, just real. SODs have been around for years....clearing legal assault from every corner. Just getting stronger. All you geniuses will see. It's coming.
ReplyDeleteSeriously . . . "hospital profits going down" is a blanket BS statement. If a hospital's profits are going down it isn't because of our spine implants. Hospital reimbursements in Spine have gone UP over the last 10 years ... the data is readily available (unless, of course, you're a puke purchasing agent).
ReplyDelete"We lose money on every spine case" . . . uhhh then why did you buy an O-Arm? Niiiccccceeeee investment.
On another note . . . I seriously doubt anywhere near 90% of the spine reps make north of $100K. My guess is the average spine rep is somwhere around $70K. There are way more spine reps out there than you think and most wash out before their 36th month. Granted their are some north of $150K but their numbers are dwindling.
Finally . . . maybe you Minnesota spine reps need your own blog . . . lots of intrastate smack on recent threads ... maybe someone inside Zimmer Spine is firing back or trying to get someone fired? Who has the time at Zimmer Spine with Crawford and Kirkpatrick "growing business" and "closing deals" LMAO!!!
8:40 is obviously not a physician. Only a moron would make the statements he/she is vurping out. There are plenty of spine reps making North of 100k and a fair number of them deserve it. My team covers EVERY single case that is on our radar, period. We bring value in many ways, if I have to elaborate on this then the ruh-tard has truly struck you.
ReplyDeleteSurgeons being businessmen is a joke, there are exceptions of course but the majority only "fancy" themselves businessmen and in reality are epic flops. If I make more than ANY of my surgeon customers then its their fault and LOL @ them for not hustling more and being limp wrists. Get off your lazy asses and go develop relationships with referring physicians, do the hard work to build your practice like I do to earn and keep your business. If I hear "where is my money" again from a fat lazy surgeon that is selective in the patients he will see (READ cherry picks) I am going to ralph! This same surgeon has no interest in working with industry in a legitimate fashion NOR are they sophisticated enough to bring anything to the table that is truly innovative if they could muster the energy.
And all this talk about a screw is a screw blah blah blah....
Technology is only ALL the same when a physician has a chip in the game. I can remember sitting down with surgeon customers and together making fun of certain D class spine companies and laughing about who would possibly use that product on their patients... ha ha, oh those were the good ole days! Then a year later that same knucklehead is part owner of a surgeon owned facility and is slapping that crap in his patients because it was the cheapest game in town conveniently forgetting the mocking a year prior. Greed is a mofo.
Ive been through all of the above in the decade ive been peddling my wares. You just go out and keep grinding, every day presents a new challenge. I love my job, although I am positive its taken at least 5 years off my life!!
I earn my pay, big difference between what you WANT and what you DESERVE.
"You don't get what you deserve, you get what you get"-Greg House, M.D.
ReplyDelete"Money it's a crime
ReplyDeleteShare it fairly, but don't take a slice of my pie
Money so they say
Is the root of all evil today
But if you ask for a rise it's no surprise that they're
giving none away..."
Let's be honest - is there anything MORE fair than sales? If you don't sell, you don't get paid. Simple as that. Who are you to dictate the commission?
ReplyDelete8:40
ReplyDeleteYou 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.
I wish there was a way to short these PODs!
ReplyDeleteLook 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.
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?
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.
thank God for all the sales reps. Society has always regarded and valued them highly. So vital.
ReplyDeleteAll 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.
ReplyDeleteWe 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...
ReplyDeleteWe 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.
There is an advocacy group in D.C.
MEDICAL DEVICE MANUf,'ACTURERS ASSOCIA TION
MARK B. LEAHEY President& CEO
1350I Street,NW Suite540 202.354.7l74 Washington,DC 20005 fax 202.354.7176 www.medicaldevices.org mleahey@medicaldevices.org
InnovationTodayfor BetterHealthCareTomorrow'"
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.
Help us preserve the American Way of life!
2011:
ReplyDeleteStryker, 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).
Synthes will continue to have loyal customers because of the AO.
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.
Globus goes public
Zimmer has some great and knowledgeable reps, just depends on the quality of acquisitions.
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.
@ 10:49
ReplyDeleteActually, 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.
2:25
ReplyDeleteGive us more to digest with more substance!
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.
ReplyDeleteHaving 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.
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.
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.
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.
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.
Amen Brother 6:27
ReplyDeleteTell it like it is, He who makes a beast of himself gets rid of the pain of being a man.
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.
ReplyDeleteLove the thread!
ReplyDeleteI'll try to be as general as possible here.
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.
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.
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!
Good news for sales reps and surgeons... if you're good, and you conduct business ethically, you'll land on your feet.
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).
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.
ReplyDeleteIts 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.
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.
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.
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.
ReplyDeleteThere 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.
Medicine, like academia has dirty little secrets that the insiders protect with all of their might.
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.
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.
ReplyDeleteThe 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.
...SpineSeller
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.
ReplyDeleteGot 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.
So why are fusion surgeries increasing?
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!?
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...
Viscous cycle, and certainly one that does not promote successful and meaningful outcomes, especially when compared to lower cost, less invasive alternatives.
JMHO.... Anonymous
POD Business Model Risks
ReplyDelete1. PODS present an ethical conflict of interest that will distort medical decision making.
2. PODS are anti-competitive.
3. PODS will most likely lead to higher implant costs and lower the quality of care in the healthcare system.
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.
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.
ReplyDeleteThis 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.
P.O.D. actually stands for "Payable on Death" in business terms,,
ReplyDeletePretty fitting for this topic I'd say.
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."
ReplyDeleteMarcus Tullius Cicero
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.
ReplyDeleteIt is of course just their analysis but it makes sense.
To Jan 25 8:20PM:
ReplyDeletemakes 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).
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......
ReplyDeleteHello!
ReplyDeletePretty 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
Feel free to ask me any questions pertaining to the neuromonitoring perspective.
Thank you, Musculoskeletal Man !