TSB decided that it would be worth a glance to look at the first company to operate within the public domain as an acknowledged POD, our good friend Dr. John Steinmann's own venture, Renovis-Surgical (www. renovis-surgical.com). What is striking about this website is Renovis' mission statement, if that is what it truly is......"Renovis is committed to providing innovative products that help surgeons meet demanding patient needs. By combining advanced materials and innovative design features with tried-and-true principals, Renovis aims to enhance device performance and longevity."
The words that really jumped out at TSB were "innovative products." So TSB decided to stroll down memory lane and check out this "innovative" product portfolio. But before we get to the nuts and bolts of the story, we thought that it be imperative that we define what the word "innovate" means. The adjective itself means to introduce "something new," or as if for the first time. What really comes to mind is the old wedding rhyme "something old, something new, something borrowed, and a lot of me-too." Out of curiosity, TSB starting to look at all that innovation that is taking place at Renovis-Surgical. Much to our disappointment, there was a lot of "me-too" products. Hey, Dr. Steinmann, where is all that innovation? At first glance that T700 reminded us of the the Synthes Large Cannulated Screws with their self-cutting/self-drilling tip, even the instruments reminded us of Synthes. As for the External Fixator, well let's just say that Stryker Howmedica would be flattered. As for the pedicle screws, there wasn't anything new. In fact they were top-loaded, low-profile, and multi-axial reminding the viewer of all of the same buzz words that currently exist in that market.
Renovis Surgical explicitly states on their website that they are a member of "AdvaMed." That is funny. It reminds the reader of biologic companies that validate their existence by claiming that they adhere to AATB standards. Being a member of AdvaMed brings to mind the story of the parent (AdvaMed) that is working diligently downstairs in their home office, when all of a sudden the kids (Renovis-Surgical) are making a ruckus upstairs. The parent walks to the bottom of the staircase and yells out, "is everything all right up there?" The kids yell back, "everything is fine dad." AdvaMed is another in a long line of lame duck organizations. AAOS, NASS, CNS, AANS, ISASS, CSRS, etc., etc., and so on. Adopting a Code of Ethics and actually living by them is debatable. But we will leave that debate to the many salespeople and their companies that actually attempt to sell to Dr. Steinmann's facilities or hospitals that he works at. Since Steinmann is so concerned with driving down the cost of healthcare, why don't companies just go in and undercut his price and let's see if he is willing to use their products instead of his own. After all, he is interested in driving down the cost of delivering healthcare, isn't he? And, he is looking for the best implant at the cheapest price? So as we begin another week in the wonderful world of spine, what do our readers think, is Renovis-Surgical innovating or are they imitating? In closing you know what the FixX once sang;
"The deception with tact, just what are you trying to say,
You got a blank face, that irritates, communicate, pull out your party piece
You see dimensions in two, state your case with black or white
But when one little cross leads to shots, grit your teeth
You run for cover so discreet, Why don't they do what they say, say what they mean
One thing leads to another!!!!!!!!!!!!!!!!
To Renovis: Open your books and let's all see how much you profit from "driving down the cost of delivering healthcare". And to the hospital where he (Steinmann) operates: Show us your markup to the payors on these low cost innovative products.
ReplyDeleteI am as against POD's as anybody on the planet, but neither of those factors is relevant to the argument of PODs being illegal or unethical or the argument whether Renovis is innovative.
DeleteIf a surgeon relies on the argument that he is participating in a POD in order to control the cost of implants but really pockets an inordinate profit commensurate to a commission and a hospital accepts utilizing a POD based on the same argument but continues to maximize markups to the payor, then it certainly is relevant as to the ethics of the POD strategy.
DeleteIf the doc can sell the product for less, or even the same, it makes no difference if he makes 1% or 50%, the amount of remuneration is irrelevant. On a basic level, if one can deliver a product for a lower cost and make more profit, that is excellent business. It says nothing about the legality of the venture. I doubt the hospital marks the products from Renovis up any more than they do for any other vendor. Do you expect them to have a different markup for POD products? Again, that says nothing about ethics or law. None of this is about the amount of money. It is the inducement to commit fraud and abuse and the fraudsters hiding behind a thin veil of innovation and cost reductions.
DeleteHospitals are consistently driving up costs across the country
DeleteTheir is word on street that the SENATE is trying to pass a bill that would control medical device costs so that ONLY hospitals can bill but they just dont get it that they are the ones, along with the MIDDLE MEN in the world who dont even cover cases or in some cases have distributor agreements that do and they too are hurting our industry.
Government need to stay our of medical device industry (at least to say how it should be billed or costs of it, they have NO CLUE!) Rather they should utilize select companies who have PROVEN cost contained organizations that allow for BOTH insurance company and medical device companies to WIN! S3 in California and Florida for example!
FOR PODS, well they may sell them cheaper to hospital to show they are saving money but when it comes down to it, the hospital is still marking it up and in some cases some of these PODS are implanting more metal than ever before and you have wonder if it really is clinically necessary. Unfortunately doctors are NOT compensated nearly as much as they used to be so they have to loook at ways to increase their compensation so they can back all their student loans, - their has to be some happy medium out their somewhere. HMMM
Looks like..., walks like..., smells like..., quacks like..., etc.
ReplyDeleteI'm happy to try the price undercut sales pitch. I'll sell at cost or a loss to get rid of the POD scourge.
ReplyDeleteWhat hospitals does this guy work at, and who is in charge of implant purchasing there? Someone please post the info & I'll post how the sales pitch went.
Are you really in this industry? POD's are not hard to find.
DeleteHow is the same address not a conflict of interest?
ReplyDeleteRenovis
(Design and Manufacture of Medical Devices)
1901 West Lugonia Ave., Suite 340
Redlands, CA 92374
Arrowhead Orthopaedics
(Orthopedic Surgery Bone Joint & Spine Center)
1901 West Lugonia Ave., Suite 120
Redlands, CA 92374
TBD (Machine Shop?)
1901 West Lugonia Ave., Suite TBD
Redlands, CA 92374
I'm assuming the checks from the hospital and from Medicare get sent to that address? And the checks to Dr. Steinmann come from that address?
ReplyDeleteMaybe if PODs grow much more, Medicare will bundle the professional fee AND the commission on the implants in one payment. While they are at it, may as well bundle the MRI, rehab, back brace, outpatient surgery center, bone growth stimulator, generic pain meds and consulting agreement fees all in one. In fact, why do the docs need anybody else to provide goods and services, they should be able to own it all and have the govt pay for all of it without any questions.
I have an appointment with the local OIG Special Agent in the Office of Investigations to see what he knows about the POD's in my area. Of course I don't have any documentation about local POD business structures, but I know what I see and hear. I think it may be plenty to get his attention. Has anybody else taken this step? He assures me I will remain anonymous unless I take it to the next level and file a whistleblower suit, but I don't really care. Honestly, I think the customers who are above board will respect me for it. If not, so be it.
ReplyDeleteDr. Steinmann is a classic frustrated DO who takes what unscrupulous industry drones and his brethren MDs have been doing for years to the next level. Let's call it a cross between TBI and Globus. Until somebody really lays down the law, he will continue to get away with it. At least he is touchingly proud of his son who with a MBA of a local community college and 2 years of work experience is brilliant at interacting with and understanding surgeons, designing instruments and marketing and sales. Of course not surprising given the brilliant gene pool he springs from. Is there no limit to the amount of slime and vermin this industry produces and attracts?
ReplyDeleteI bet he will next claim he invented the eponymous pin..... And charge royalties.
DeleteStop whining!
ReplyDeleteGoing to your local investigator accomplishes nothing! They are lazy and most of them have no idea the legalities of self referral, shell games, etc.
You crush the pod scam by all legitimate reps standing up and refuse to sell products from companies that cater to pods. We all know who they are. So suck it up and do the best thing for our industry
My question is why aren’t malpractice attorneys suing the hell out of these greedy surgeons?
You can’t tell me that the greed that exists won’t cause them to add additional levels, cross connectors, and cages to make more money.
Why haven’t they sued every surgery center in the us for using shanghai implants, deviating biologic regimens compared to standard practices they use in other facilities that they haven’t invested in. We have all witnessed it unilateral fixation, surgeons using peek cages in large hospitals and cutting down bone in facilities they are investors in, using good biologics in real hospitals and limited to crush in they are investors in.
Last but not least never discount spine is the cash cow for every hospital!
They wouldn’t be in it if they were losing money
So it sounds like you have been to them as well if you know them to be lazy and ignorant. POD's don't use legitimate reps so your idea wouldn't effect them in the least.
DeleteQuestion: How can a lawyer access patient records to look at implant choices, wasted implants, etc? My guess is that they cannot get that info. But I bet the HHS (OIG) can get records.
If nothing else, I would like to see an OIG agent snooping around and maybe interviewing some docs. Regardless of their ability, or lack thereof, it would make for some tight sphincters.
Hospitals have to keep records of all that goes into a patient. Many try to hide the info, because for majority of them, they are increasing the implant costs and their are laws across the us and each state varies as to what they are allowed to bill. Its based on PAID COSTS, but if hospitals actually follow that law then they would LOSE MONEY.
DeleteAttorneys can subpeona hospital and the co that supposedly brought in the implants.
Its crazy, the abuse out their is gonna hurt the entire industry. For the guy that is talking to OIG, that is NOT gonna solve anything, they are too back logged and their is so much money they dont have to research or go anywhere with info they receive, heck did you see the article in WSJ FEB 9th about Calif Black Market Surgery? That guy is still engaged in his thing so just forget the govt. The industry is changing, more PODS are being developed but I can tell you this for a fact, their are some hospitals that REFUSE to work with PODS - more so on MID WEST than elsewhere they will actually make you sign that you are not a pod. For the others, well I think their hands are kind of tied, they want surgical business and like everything else they still get to mark it up so they dont care!!
Just looking at the website and was surprised to see Trace Cawley on there. Good guy. I'll never take issue with someone earning a living but it seems a shame that he is working with Steinmann.
ReplyDeleteWow. I never knew he ended up there. Depressing
DeleteOIG nails a bone growth stimulator company for paying a doc to prescribe. No mention of the doc being in hot water, his PA is charged with AKS violation
ReplyDeletehttp://www.justice.gov/usao/ma/news/2012/April/GuerrieriThomasPleaPR.html
Anybody know what company this is? Or the doctor?
Orthofix
DeleteWhat about phygen? is that company a POD or not?
ReplyDeleteIs Phygen a POD? Puhhlease.
DeleteAsk the OIG what their research says so far.
Just like PDP who attempts to change the model and attempt to make it legal within some sort of framework.
It's not about POD or whatever your framework is- it all comes down to the Single Purpose law. TSB nailed that one and that is why you see an increase in AKS convictions lately.
Wow, pulling out lyrics from The Fixx. Nice job TSB.
ReplyDeleteAs far as innovating, Dr Steinmann did in fact innovate, it's just not with his products. Rather it is with the POD. Innovation isn't just products, it can be service too. But that doesn't make it ethical or legal. He just figured out a new way to scam the system.
what are'nt hospitals get on board like scripps did in So cal? refuse to do business with anyone they consider working with, for or are a part of a POD??
ReplyDeleteDepends on the hospital, their market, their core values and most of all, whether they can pull it off without their surgeons taking their cases across town. I think you would be hard pressed to find a hospital administrator who likes the idea of having to, at some point in time, negotiate prices downward with his surgeon customers. Thats not a good position to be in. Just imagine the conversations you have had with hospitals regarding pricing contracts, captivated pricing etc and then imagine the surgeon having the same conversation with them. Its ridiculous to even ponder that scenario.
ReplyDeletecapitated, not captivated, although basically the same thing
Deletewhile I see what your saying, look at the way Kaiser controls what their surgeons use...becasue they can. The surgeons are employeed by them, and their bonuses are reflective of staying within those boundries.
DeletePhysicians that are employees of the hospital is a different issue. The hospital can clearly control whether or not they get involved in a POD. Do those Kaiser employed physicians belong to a POD?
DeleteI am confused because I thought the first POD was started by a Dr. Park in Missouri and not Dr Steinmann. Dr. Park is no longer in the country because of his POD.
ReplyDelete12:45 p.m. New Hampshire legislators passed H.B. 1725, prohibiting healthcare practitioners, including physicians, from referring, recommending, ordering or arranging for the acquisition of medical devices for patients under their care if the medical device is supplied directly or indirectly by an entity in which the referring practitioner has a direct or indirect ownership interest. (Source: New Hampshire Liberty Alliance)
ReplyDelete12:45 Laughing,, New Hampshire passed a law? Puh-LEASE,, WHO cares,, Who's next, Vermont? States like TX, CA, NY, PA, FL, are the ones who need to stand up to these shams.
ReplyDelete12:45 I am with you. I think what they meant was that if states like CA, TX, FL where to stand up others would take notice and possibly follow. I am a device rep in Cal and have seen my business over the last 5 years decline because of these so called "POD's" operating freely without retrictions for the hospitals I work in. Mostly because they admin have no idea.
DeleteHey 8:18, zip it knucklehead!
ReplyDeleteIf you are in the device industry and NOT associated with POD's then any movement in this direction is positive.
Way to go New Hampshire, no taxes and no PODs Live Free or Die I'm moving.
ReplyDeleteAlphatec.
ReplyDelete?
Delete