Other Articles

Biologics for Spine: Where We Are Now
Dr. Jeffrey Wang, Chief of the UCLA Spine Service and Director of the UCLA Spine Surgery Fellowship, discusses the exciting happenings in spine biologics, including growth factors, the use of different genes, and injecting stem cells into the disc. And then there are the challenges, namely the disc environment and the funding environment.

Physician Medicare Payments: Grandma vs. Docs
The fight over Medicare physician payments in Congress has been reduced to a fight over limited public dollars between Grandma and her physician. Is this a prelude to how public health care policy will be decided in the future? Read about the tussle here.

Spine Niche! Opportunity in the Spinal Deformity Market
Given the myriad of start-up companies pursuing the same patients, product differentiation and solutions for specific target markets could be the key in the future. Using the PearlDiver Patient Records Database we estimate procedure volumes for posterior fusion as a treatment for scoliosis—followed by the results of a study identifying complications associated with instrumented posterior thoracic fusion in treating scoliosis.

AAOS Political Action Committee
Active players in the orthopedic field know the importance of the AAOS Political Action Committee (PAC). On the cusp of hot topics affecting physicians and patients, the AAOS PAC works diligently to provide data to members of Congress and improve the present and future of orthopedics.

Who ARE These Guys?
Every 60 seconds or so a surgeon tears the cover off an Integra LifeSciences package. Quietly, this company has become the seventh largest medical implant manufacturer serving orthopedic surgeons in the world. Where to now? Would you believe $1 billion in two years? How about $2 billion by 2015?

Redemption in a Mechanism of Failure: The TOPS™ Story
Impliant’s TOPS™ System had a “squeaker” in its clinical study. After a voluntary suspension of the study by the company and finding the mechanism of failure, the FDA has approved a resumption of the study. What insider lessons were learned? Class starts here.

Who is Numero Uno in the PearlDiver Database!! Are You Surprised?
The answer may surprise you. Is it sore backs, aching hips, sore knees, fingers? PearlDiver details 3.8 million spine related complaints—complete with demographic information and charging information. But that’s not #1. PearlDiver also lists 3.5 million large joint complaints. Sorry, still not #1. What could the most common orthopedic complaint possibly be? To get the surprising answer…read on.

What the Knees Need: Baby Boomers and Their Options
Knee patients often show up at the doctor’s office with recurrent mechanical symptoms. It is up to the orthopedist, says Dr. Giles R. Scuderi, Director and orthopedic surgeon with the Insall, Scott & Kelly Institute in Manhattan, to thoroughly assess the patient and then determine if nonoperative treatment will do, or if the person needs a unicompartmental or total knee procedure.

Physician: Report Thyself
The government says its healthcare anti-fraud efforts are working and it wants to encourage physicians to self-report possible fraud. How well did the government do in 2007 and what about those deferred-prosecution deals with undisclosed evidence? Read about it here.

Revising the Statistics
The word that orthopedic patients least want to hear is “revision.” Who, in the universe of large joint patients, do we expect to see on the receiving end of this news? If you guessed “the elderly” you would have been wrong. The reality of who is hearing “revision” may come as a surprise. Read what we found when probing PearlDiver’s database.

Where Is Ben Now? Trends in Venture Capital
What is being funded by VCs and why? First of all, spine is having to share the spotlight, says Gary Stevenson, Managing Partner at MB Venture Partners, LLC. Here Stevenson outlines what constitutes an attractive investment…he also highlights issues that are affecting the distribution of VC funding.

The Hounds of Wall Street
Conventional wisdom on Wall Street is that ArthroCare is in a bare-knuckle fight to the finish with short sellers. Which leaves us with the dominating question: If ArthroCare is essentially a “lame duck” growth stock, then why are sales, earnings, and the stock price contradicting the short seller’s dire predictions and even outperforming consensus analyst forecasts? We have the answer.

The Era of “Tell Me Right Now” Dawns at FDA
The FDA wants the next phase of post-market oversight to change from self reporting to proactive surveillance. How? Through the Sentinel Initiative. Read what it means to device manufacturers here.

The Day After Tomorrow: Complication Rates and Instrumentation Trends in Posterior Lumbar Fusion
Could PearlDiver be the Nostradamus of spinal instrumentation? This most commonly performed surgery on the lumbar region of the spine increases fusion rates and improves spinal stability—but what about complications? Using PearlDiver’s database we find the answers. Are you ready for some quatrains about what happens next?

You Try It. No You Try It First: New Technology Adoption
What are the forces working for and against new technology adoption? Youth versus age, risk taking versus conservatism, and the economic realities of the day, says Dr. Rick Guyer, President of the Texas Back Institute.

Cheaper, Thinner, Faster, Stronger
In this, the second of our series of three articles on innovation, we tackle the question: How do you measure medical technology innovation? While difficult, measuring innovation is NOT impossible. Why? Well to start, and in the immortal words of Supreme Court Justice Potter Stewart, “We know it when we see it.”

SAS Crosses the Rubicon in Miami Beach
The SAS 8th Annual Global Symposium in Miami Beach may have crossed the Rubicon. How? Read about the Society’s opportunities for growth and collaboration as its new President lays out a vision for the future.

The good news is that New York Attorney General Andrew Cuomo has reached a doctor ranking agreement with another large insurer. The bad news is that Cuomo has reached another doctor ranking agreement.

As attendees at the recent NASS meeting heard, doctor ranking programs are a hot item within the healthcare industry. Major insurers nationwide either operate or are in the process of developing these programs with the hope of curtailing rising healthcare costs.

Cuomo threatened insurers such as CIGNA and Aetna over their proposed ranking programs because, he said, consumers had trouble interpreting the rankings and insurers had a profit motive that could affect their program of physician measurement. In other words the rankings were about, YIKES, money!

Cuomo reached a similar compromise agreement with CIGNA in October.

The American Medical Association liked the deal. Nancy Nielsen, M.D., PhD., President-elect of the AMA, called the deal "an important step toward ensuring that physician evaluations are used primarily to enhance the quality of patient care."

She said a lack of proper oversight "has allowed health insurers across the country to unfairly evaluate the individual work of physicians. Physician evaluations can be skewed through the use of economic criteria, insufficient sampling of patient cases, questionable quality measures and poor adjustments for risk. Distorted evaluations can mislead patients and erode confidence and trust in physicians, and disrupt patients’ longstanding relationships with physicians who have cared for them for years." In other words, those greedy insurance companies tried to get greedy under the radar.

She also noted that both Aetna and CIGNA "have agreed to renounce physician evaluations and rankings based solely on economic factors and instead they will adopt a balanced approach that acknowledges physician ratings have a risk of error and should not be the sole basis for selecting a physician."

Aetna's program, Aexcel, covers 12 medical specialties including cardiology and ob-gyn, and it includes about 41,000 doctors nationwide. The program is in 35 markets, and it will enter another 4 markets in January. Aetna says that as of this month, Aexcel is offered by 45 customers—mostly employers with self-funded health plans—to nearly 600,000 members nationwide.

The agreements involve special smaller networks of physicians that some insurers offer based on their assessment of the doctors' clinical quality and cost-efficiency. Workers would pay a smaller share of medical bills if they use those small networks. Aetna said it is taking New York's model nationwide. CIGNA also said it plans to go national with its new standards.

Doctors' clinical quality and cost-efficiency will be evaluated based on "best practices," as recommended by groups that include the American Heart Association and American College of Obstetricians and Gynecologists. Doctors will be given a chance to appeal a decision if they are not included in the chosen networks.

“Choosing a doctor is obviously a very important decision and the information health care companies provide to consumers must be fair and complete. Health insurance companies are beginning to realize if they want to implement a doctor ranking program, they should adopt our national model, which is supported not just by insurers, but also by national physician and consumer groups,” said Cuomo.

The model reforms doctor ranking programs by compelling insurers to fully disclose to consumers and physicians all aspects of their ranking system. Additionally, under this model, the insurer must retain an oversight monitor, known as a Ratings Examiner (“Rx”), who will oversee compliance with all aspects of the agreement and report to the Attorney General every six months.

Under the national model, insurers will:

• Ensure that rankings for doctors are not based solely on cost and clearly identify the degree to which any ranking is based on cost;
• Use established national standards to measure quality and cost efficiency, including measures endorsed by the National Quality Forum (NQF) and other generally accepted national standards;
• Employ several measures to foster more accurate physician comparisons, including risk adjustment and valid sampling;
• Disclose to consumers how the program is designed and how doctors are ranked, and provide a process for consumers to register complaints about the system;
• Disclose to physicians how rankings are designed, and provide a process to appeal disputed ratings;
• Nominate and pay for the Ratings Examiner, subject to the approval of the Attorney General, who will oversee compliance with all aspects of the new ranking model and report to the Attorney General’s office every six months. In addition, the Ratings Examiner must be a “national standard setting organization” and will be national in scope, independent, and an Internal Revenue Code § 501(c)(3) organization.

So why was this both good and bad news? It was good news because someone is providing adult supervision over insurance companies’ ranking of doctors. It’s bad news because the adult is a politician.