Other Articles

Elegance in Spine: Extracavitary Approaches
The delicate task of dealing with spinal problems is getting a bit less complex, says Dr. Francis Shen. Orthopedists can now remove a section of rib and approach the front of the vertebrae from the back in an oblique direction.

Endotec Beats FDA, Strikes Blow for Innovation
Endotec has struck a blow for every orthopedic surgeon who wants to develop a better device. See how the company’s founders took on the FDA and got a federal judge to charge the agency with “stymieing progress and technological advancement.” How did they do it? Read on.

From Obesity to Osteoarthritis, the Carpal Tunnel Connection
It’s certainly no surprise that Carpal Tunnel Syndrome (CTS) is an exceedingly common orthopedic malady. But, as PearlDiver’s data show, the linkage between obesity, osteoarthritis and other conditions to CTS is most surprising. Check it out.

Using DNA to Predict Scoliosis
Six million people (estimate from the National Scoliosis Foundation) have scoliosis in one form or another. The primary age for onset of idiopathic scoliosis is 10-15 years old. Finally, there is a test which can reliably predict scoliosis. Fewer X-rays. Lower cost. Better outcomes.

New Capital, New Science for Cartilage Repair
$36 million invested in the last couple of months. TiGenix has more than that in the bank to fund market penetration. Then a new paper last week finds molecular cause of OA. Cartilage repair momentum is building.

Should I Become a Physician-Employee?
Large healthcare institutions are increasingly purchasing orthopedic practices. What does this mean for patient referrals? How beneficial can it be for orthopedists? The upside is more stability, among other things…and one of the downsides is loss of freedom.

Outrageous Whistleblower Lawsuit Challenged
Spine surgeons sued by whistleblowers in Boston are fighting back. Their lawyer is outraged and says the claimants are just shopping an old and settled case to another judge. Is this the proverbial lipstick on a pig? Find out.

Medical Education Under the Microscope – Is It Up to Today’s Challenges?
Where is the line drawn between what medical schools, residencies, and professors should provide to students and what doctors-in-training should reach for themselves? Here are the results of interviews with three senior surgeons, who opine on things such as attitudes, how people learn, and the possible effects on the field.

The Underlying Meaning of Zimmer’s Purchase of Abbott Spine
From the price paid to the timing, this transaction held an underlying meaning for the entire spinal implant industry. Zimmer, the $4.2 billion (revenue) diversified orthopedic company is now #5 in spine. More to come?

Resurging Lumbar and Cervical Total Disc Replacement Markets! New PearlDiver Estimates
Rumors of the TDA market’s demise were premature. Increasingly positive long term patient data is at the core of a resurging lumbar and cervical TDR market. Senior analyst Matt Menze tackles the TDA market and interviews one of the fathers of TDR, Dr. Scott Blumenthal from the Texas Back Institute. Where is this market actually heading? We think to the $2 billion range by 2015. All details here.

Six Days in June – Biomet and Zimmer Battle for Distributors in Kentucky
Documents filed recently in a Kentucky lawsuit pull the curtain back on an epic battle between Biomet and Zimmer. For six fevered days in June 2007, Biomet CEO Jeff Binder and founder Dane Miller went into the trenches to save one of their own. For all the details, read on.

Multicenter Clinical Trials: Do They Get the Respect They Deserve?
They’re not fast or sexy, but they are critical…large trials, that is. With multiple sites and principal investigators who donate their time, large trials are more complex—and normally yield more actionable data—than smaller, quicker studies. But large trials don’t always get the respect they deserve. And, says at least one physician-researcher, this could affect the future of the field.

Patent Wars: Medtronic Attacks NuVasive
MSD’s lawsuit came amid a period of declining spinal implant market share – from a peak of 60% in late 1998 (just prior to being acquired by Medtronic) to, we estimate, 36% currently – and a growing sense that MSD’s reign as the king of spine was coming to a close. What’s really behind Medtronic’s attack on its former senior exec? Read on.

While being active in national organizations can be a great chance to gather new information and meet up with colleagues who haven’t seen you since you put “M.D.” behind your name, working with local orthopedic societies can deepen your connections with important happenings right in your own backyard.

Such is the case with the dynamic Pennsylvania Orthopaedic Society. Fifty-two years ago a group of Pennsylvania orthopedic surgeons held their first meeting in Atlantic City, at the time a major resort area.

States Dr. Jon Tucker, President of the Pennsylvania Orthopaedic Society, “Just after World War II orthopedics was growing leaps and bounds and state societies were cropping up all around the country. The Pennsylvania Orthopaedic Society was initially established to help like-minded individuals connect and share their experiences. As time went on the focus shifted to scientific achievement and continuing education. The environment has changed in the last 20 years, however, so while we still aim for those things, out of necessity we now have taken on a significant legislative and advocacy role.”

Adds Dr. Chip Hummer, III, Past President of the Society, “The original goal, which we maintain to this day, was to foster collegiality among orthopedic surgeons in Pennsylvania. Now, with two meetings each year, we also aim to encourage academic discussions and interactions. This is not difficult given the high caliber, nationally recognized experts who speak at the meetings.”

But back to politics. “Advocacy is the mandate of the day,” says Dr. Hummer. “Since 1992 we have had a political action committee (PAC). Given that many if not most healthcare issues are regulated on a state level, we decided to have our own PAC. Over the years it has grown from $50,000 per year to the largest medical PAC in Pennsylvania. In an average election cycle we might distribute $300,000 to candidates who we think will benefit orthopedic patients and surgeons. This is how things are done these days. If you are not engaged in the political process you don’t have a seat at the table…you’re on the table. Since medicine is the most regulated industry and receives the vast majority of its funding from public sources, surgeons really need to be involved in the political process. As such, you have a great chance to promote an agenda that is beneficial to patients and physicians alike.”

With their fingers on the pulse of orthopedic happenings in the Commonwealth, the leaders of this state society closely track trends that affect their fellow orthopedists. Explains Dr. Hummer: “We spend a lot of time educating legislators. Likely the most significant topic we’re covering with them nowadays is M-CARE, a state-run, pay-as-you-go catastrophic loss fund. If there is an increase or decrease in medical malpractice payments in a given year the cost of that fund goes up and down based on how many cases are in the system. A basic catastrophic fund was formed in the 1970s in the middle of the medical malpractice crisis. At that time the insurance companies were leaving the state and the only way to get them to stay was to provide coverage for the second layer of payments. While it stabilized the market at the time, because of excess litigation in the late 1990s, the M-CARE fund was formed from the catastrophic fund.”

Continues Dr. Hummer, “This resulted in a program called M-CARE abatement, which mandated that premiums for the second layer of insurance for high-risk specialists in Pennsylvania be paid by state money and that the funding mechanism be a tax of $0.25 on each pack of cigarettes sold. Also, non-high-risk physicians would get half of their premiums paid by the state and they would pay the other half. And the difference between high-risk and non-high-risk is significant. My premium in 2000 without any cases against me was $110,000; half went to the state-run entity and half went to the insurance carrier. During the same period an average primary care doctor in Pennsylvania was paying a premium of between $6,000 and $9,000 a year. M-CARE, enacted in 2002, had to be annually renewed by a legislative vote and signed by the governor, meaning, of course, that is an annual fight. It has not been renewed for 2008 so on March 31 all orthopedic surgeons had to pay their M-CARE premiums. The Society is working hard to extend the M-CARE abatement. This is critical because there is $2 billion of unfunded liability in the system; i.e., cases that are either brought forth already and not yet adjudicated or in the pipeline and may not have been filed. How is that going to be paid off if we dispose of the M-CARE fund? The options are to pay it off through public resources or have the doctors who made the mistakes and created the problems take responsibility for it. Our argument is that unfunded liability has nothing to do with bad doctors—we have no more ‘bad doctors’ than any other state. The current law saying that doctors and hospitals must pay is bad public policy. The state government has proposed a legislative package that links M-CARE abatement, the retirement of unfunded liability, and expansion of coverage for the uninsured. These other elements were thrown in, but it is controversial because money from the cigarette tax was set aside to deal with the medical liability problem; now some want to appropriate it for other purposes. The Society doesn’t advocate for a single solution…we advocate for a timely solution. If M-CARE abatement is not extended and the unfunded liability is not paid off by public means in a reasonable amount of time, we will see yet another significant outflow of doctors from the Commonwealth.”

Orthopedic surgeons in Pennsylvania are confident that their concerns are being taken seriously by their state society. “We have won recognition and awards for the quality of our organization,” states Dr. Tucker. “Our Society was rated as the top state professional society in 2007 by the AAOS, and we have been awarded some sizeable small grants and been given accolades from AAOS. All of this is possible because of the contributions of our active membership; we have almost 1,000 orthopedic surgeon members, one-third of whom are very active.”

A pleased Dr. Tucker notes, “Our members have banded together on so many different levels. This allows us to run a well-funded organization, with four full-time employees in the state capital and a tremendous number of volunteers. There are eight doctors on our executive board, with 22 doctors on our general board who attend four meetings per year at their expense. For our members we offer between 12 and 14 hours of CME credit for $400. That is one-third the price of any other meeting that an orthopedic surgeon can attend. These reasonable rates are important as money becomes tighter and CME requirements increase. I am also proud that we were voted by the nonpartisan Pennsylvanians for Effective Government as one of the top ten most effective PACs in the state.”

As all organizations do, the Pennsylvania Orthopaedic Society must confront its challenges. And one of these issues provides proof that instability in the field can affect even nonprofit entities. States Dr. Tucker, “Every year we try to increase our active membership, in particular the percentage of members who attend meetings and participate in grass roots political campaigns. The most pressing challenge now is sponsorship by industry of our meetings. The current AdvaMed restrictions and Department of Justice investigations into implant manufacturers have made some companies reluctant to sponsor meetings, even though our group is a nonprofit. We hope, however, that this is a temporary trend. In the meantime, the more doctors that attend the meetings, the less we have to rely on sponsors.”

And the outlook for the future? Explains Dr. Tucker, “The megatrend is that more doctors are becoming employed by large hospitals, meaning that more of our members are employed physicians whose needs are different from those of private practitioners. As an organization we must be relevant to everyone, but it is a bit of a bifurcated membership. We must ensure that we are useful to the employed physician, who needs a different set of business skills. For example, these surgeons must know more about free agency contracts and the rights and responsibilities of being physician-employees.”

With surgeons squeezed for time, anyone trying to capture their attention needs to provide proof positive that they will get concrete benefits from participating. Dr. Hummer: “An ongoing challenge is to ensure that we continue to demonstrate value to our members and potential members. Some individuals are especially interested in our academic offerings, while others are more focused on the social aspects of the group. Regarding the political arena, however, I can assure someone that if he invests $1,000 in our PAC he will get a return of $25,000 to $30,000 per year. (The $1,000/$25,000 ratio is an approximation based on the annual value of M-CARE abatement since its inception.) And members are kept abreast of the latest happenings that affect them. If there is a political issue that’s time-sensitive, we can immediately alert members, who can call their elected officials. We have learned the importance of rapid mobilization of our resources.”

Now that’s a surgical strike.