Weekend Op-Ed Piece

As TSB bloggers attempt to legitimize, question, and expose POD's, the debate rages regarding the legality or illegality of this business model. Proponents of PODS that have sought a legal opinion argue that the law and free markets substantiate the pursuit of this model, while those that dissent argue that not only is this illegal, it is a blatant attack on the industry, and your ability to earn a livelihood.  Regardless whether you agree with POD's or are adversarial, eventually, the validity of POD's will be tested in a court of law. What does not bode well for POD's is that this is no longer a local, or regional business model, this business model is becoming viral, and as it picks up momentum, the national press, OIG and DOJ is paying close attention to how business is done in the spine industry. The battle lines have been drawn.

If one looks at the evolution of the industry, there were many surgeon champions that had been the impetus for today's emerging technologies that have enhanced the publics quality of life.  These individuals were pioneers, scientists, and artists.  Somewhere around the mid nineties, things began to change.  It was a changing of the guard.  It was a generational change. Surgeon no longer viewed themselves as clinicians, they wanted more, they began viewing themselves as entrepreneurs. Surgeons were beginning to question why there wasn't additional financial incentives in their collaboration with corporations.  Of course, corporate America obliged.  Sofamor Danek, DePuy/Acromed, Synthes, Stryker/Osteonics, Biomet, Smith and Nephew/Richards, and Howmedica.  These companies were the breeding ground for the evolutionary change that has transpired. They all had their own footprint as to how business would be conducted.  Let's help surgeons market their practice, let's provide them with educational grants, let's hire them as an educational instructor.  Inducements whether one acknowledges it or not. Welcome consulting hysteria. Overnight,  TSB remembers sales people and distributors changing their sales tactic.  No longer were you selling on features and benefits, you began selling on futures, and surgeons loved it. Royalties existed, and rightfully so, but were never used as a means to an end as it was made famous by Blackstone and by today's denizens. How many of you heard this famous line, "Doc, if you use our product for 30-60 days and are happy with it, we will tender you a consulting agreement." How many surgeons business was bought by feedback on a screw or instrument modification?   A by product of this behavior are the convoluted relationships that make this industry a breeding ground for greed.  And unlike Gordon Gekko, or Mad Money Cramer, greed is not so good. It breeds contempt for rules, and the laws of nature.

Those advocating the legitimacy of POD's argue from a Darwinian point of view, believing that this is laissez-faire capitalism at its best,  where all parties are free from state or federal intervention, restrictions, regulations, and enforcement.  It can also be a Machiavellian philosophy where the ends (profits) justify the means (PODS), even though TSB must question whether some of these people even know who Machiavelli was?  In defense of those individuals involved in POD's, they really don't worry about what is right or wrong, all they worry about is whether they are profitable.  A sociopathic behavior?  TSB will leave it to the masses to be the judge. Winning at any cost can, and most of the time, does come back and bite you in the arse, just ask Charlie Sheen.

So as sales people and surgeons battle amongst themselves, the powers to be, corporations, its executives, hospitals, hospital administrators, Wall Street and most of all the insurance industry are laughing all the way to the bank. Suckers!  As you fight amongst yourselves, you perpetuate and condone the aberrant behavior and greed that the aforementioned parties exhibit.  That is where the real power lies. It's not free markets economics that drives a POD, it's an inherent arrogance that makes someone believe that they can do it better, that you can actually effect change. As the insurance industry barrels into its third straight year of record profits, as hospitals continue to prosper, as CEO's continue to manipulate markets, you are getting into a street fight amongst yourselves.  As hospital admissions decrease, insurance premiums increase, and physician reimbursements continue to decrease.  Some of these players are showing their ineptitude, their lack of fight, a lack of vision, blaming some sales rep for driving up the cost of healthcare.  As Clara Peller once said, "where's the beef?" Whom do you think is paying for those $500 dollar bottles of wine that Lukianov drinks?  Whom do you think is paying for the Cohiba's and Cristal that you smoke and drink at the Viscogliosi Brothers soirees?  Whom do you think is paying for your lap dance?  As a student of great civilization, one of TSB's favorite lines is, "Die religion....ist das opium des volkes."  Unfortunately, greed is the religion, it comforts you, it gives you a higher purpose, it's like a drug that makes one feel good.  So in closing remember what the great John and June Carter Cash sang;

We got married in a fever, hotter than a pepper sprout, We've been talkin' 'bout Jackson ever since the fire went out, we're going to Jackson, we're gonna dig around, we're going to Jackson, look out Jackson town.

So at the end of the day as the delivery of healthcare approaches 22-24% of the GDP, it will be interesting to see how the POD phenomenon plays out.