The Master Debaters

Recently that SHILL of a publication, OTW, ran an article entitled, "PODS, The Great Debate."  TSB thought our readers would be taken back in time when Wiley College debated Harvard.  No Denzel Washington on this set.  The Great Debate was centered on the following question; "Should physicians own their own means of implant or instrument distribution?" Hey Jimmy Olsen, why not pose a simpler question?  To call Doc Steinmann one of the most articulate and knowledgeable experts in this field is rather entertaining.  Though, TSB must admit, Steinmann's jab at Biomet regarding their recent run in with the OIG/DOJ must have cut like a knife through Jeff Binder.

Let just cut through the BS, rather than debating the issue, the question that should have been asked how does the industry enforce proper intent, structure, and conduct that would make everyone compliant with the laws?  Ever hear of checks and balances?  How does the industry ensure that it advocates and sustains free market enterprise without stacking the deck?  We do like to think of ourselves like our Wall Street Brethren based on our behavior.  How does the industry contain cost, when the industry is built on growth and profitability?  How does the industry play a role in delivering affordable healthcare in a fee for service model?  If proper intent is about demonstrating cost containment, why don't surgeons and hospital administrators allow everyone to compete in a closed bid system?  Talk about leveling the playing field.  If one's intent is to eliminate one intermediary to benefit by extracting profits out of the industry by developing another model, what is there to debate?

Whether our readers agree or dissent, PODS are nothing more than another entity based on insider trading with the objective of extracting as much profit as they can out of the industry.  If PODs truly believe that they are driving down the cost of delivering healthcare, why haven't surgeons agreed to take a decrease in reimbursements?  In a free market everyone should have the ability to compete. There will be an outcry. TSB you're a socialist.  How could you suggest a closed bidding system? As Steinmann states; "legally compliant structure for surgeon ownership of distribution is available based on the position of the Inspector General."  Bill Kolter of Biomet counters by challenging whether 60% of revenue generated by PODs comes from non-investors.  TSB's question to other surgeons would be why would you want to make the Dr. Steinmann's of the world richer than they already are without reaping your own profits.  Why not each individual surgeon in this country start their own POD?  Like this they could hire their girl friends, sons, or daughters and ensure that they have a job.  But then who would make the donuts?  As TSB loves to say, "if surgeons are so unhappy with how little money they make, why not become a plumber or carpenter?"

Kolter is correct when he states that PODs depend on surgeon investors, why else would anyone subsidize some other surgeons venture?  Self-referral?  Kick-back?  You be the Judge and the Jury. What Steinmann fails to understand is that it is not only Biomet that maintains that surgeons, hospitals, and manufacturers cannot be trusted to act honorably, the majority of us that have been in this business longer than Steinmann can definitely name the cast of characters that have had their hands out since day one.  If the Anti-Kickback Law's "One Purpose Rule" tests self-induced referrals in order for a surgeon to gainfully profit from their actions, then why doesn't the OIG put them to the test?  

Steinmann talks about Bill Kolter not providing solutions, but what does Steinmann provide as a solution when he cuts one middleman out only to be replaced by Steinmann and his cronies? Steinmann is the typical surgeon who complains about the escalating cost of healthcare and deflects the blame on the weakest link in the system, the distributor.  As companies decrease commissions to increase shareholder profits it is ironic that Steinmann himself has a need to be a distributor, hiding behind the AMA and AAOS Code of Ethics.

"It is unethical for an orthopedic surgeon to receive compensation from a manufacturer for using a particular device or product." Hey Doc, you ever hear of Blackstone Medical?  They were the poster child for surgeons receiving compensation from a manufacturer for using a product, and the rest is history.

But for arguments sake, isn't Steinmann himself "accepting payment of any kind" when he profits from his own company distributing and using products that he sells to the hospital, even at a cheaper price?  What the Steinmann's of the medical device world fail to understand is that there is a de facto absence of ethical standards.  The AMA nor the AAOS have any legal authority to enforce any actions upon its members because these organizations are lame duck at best.  So in closing, all one has to do is look in back of any AAOS, AANS, CNS, or NASS publication to see how stock investments, royalties, and consultancies affect a surgeons choice only to be determined by one's vested interest.  TSB wants to know what our readers think?