Other Articles

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.

Spine Gainsharing Through the Looking Glass
The feds have issued their first opinion allowing a spine gainsharing proposal. In Alice in Wonderland style, Through-the-Looking-Glass logic, they said the proposal was improper but would not impose sanctions. Who is the author of such a plan and what’s her secret? Read here.

PearlDiver Data Raises New Questions About Synovial Injections
Synovial injections for painful knees have been approved for use since 1997. If the goal is to improve the quality of life for the patient, is that being accomplished? The latest numbers from the PearlDiver Patient Records Database cast doubt.

Plantar Fascia: The Annual 3 Million Patient Market
“Plantar Fascial Fibromatosis (ICD-9-D-728.71) is right up there in frequency with pain in the shoulder joint, degeneration of lumbar intervertebral discs, pain in the lower leg joint, and carpal tunnel syndrome. As usual, PearlDiver has this market mapped out.

Orthopedic Incubators: Where Little Ideas Grow Up
Business incubation, also known as acceleration, can be a wild ride. Thus it’s best to approach it armed with the solid advice of experienced professionals. Who should take this ride? What can venture financiers bring to the table? These questions and more are answered by two seasoned VC professionals.

Just Say No to CMS Potential Coverage Decision List
Unless you want to be on the receiving end of a non-coverage letter, just say no to CMS’ proposed list of potential National Coverage Decisions. You’ve got until September 28 to make your case. Read what a leading industry consultant and analyst have to say.

Staking a BIG Claim
Alphatec, the company whose IPO collapse served as an object lesson for all medical device companies, has nearly completed its turnaround. The key? New management and new technology. Exhibit A: OsseoFix™—with it Alphatec stakes a claim to the next big spinal implant market.

The Pennsylvania Orthopaedic Society
The Pennsylvania Orthopaedic Society, 1,000 members strong, tackles a variety of challenges on behalf of patients and surgeons alike. According to AAOS, they were the top state professional society in 2007. Fifty-two years in the making, here is how they did it.

Percutaneous Spine Procedures: Just Setting the Stage for Fusion?
Selective nerve root blocks, laminectomies, and percutaneous discectomies. How many times do these procedures lead to a full blown spine fusion? Using PearlDiver’s Patient Records Database, we longitudinally tracked patients to find out. All we can say is that after surveying the 3.9 million spine patients in the PearlDiver database, the answer may be different from what you’d expect!

Physicians Targeted by Whistleblowers
The whistleblowers that targeted Medtronic in 2006 are now aiming their guns on 136 physicians and distributors as we move into the next era of the “Great Disruption.” Read about their qui tam lawsuit in Boston and what it means for industry and surgeons.

Zimmer’s Bet on Compliance
Is Zimmer’s Enhanced Compliance Program going to cost it market share? Analysts demanded answers from CEO Dave Dvorak during the quarterly conference call on July 23 that also included the announcement of the Durom® cup suspension. Dig in here.

Faculty Compensation in Academic Medicine
Dr. Sanford Emery, Chair of Orthopaedics at West Virginia University, has put his M.B.A. to good use. Delving into the issue of compensation in academic medicine, Dr. Emery and his colleagues surveyed 31 orthopedic programs and conducted in-depth interviews with leaders of eight programs. Their findings include information on the compensation structure and point systems.

Engineering an Unfair Advantage
After $1.2 billion in equity capital, what did the tissue engineering pioneers accomplish between 1990 and 2000? For one thing, LifeCell, Integra and Osiris. For another, a generation of wiser, tougher managers who are targeting the big orthopedic markets. Now all they ask for is an unfair advantage. Are the big guys ready?

The Pain of Fashion! 4 Million Patients Every Year and Growing
Eighty-eight percent of all women wear shoes that are too small. Fifty-five percent developed bunions. Despite costs that can reach as high as $20,000 per procedure, four million patients every year seek surgical relief. Want to know the footprint of this market? Read on.

Oxiplex® – “Not Approvable”
The FDA’s Orthopaedic and Rehabilitation Devices Advisory Panel said FzioMed’s Oxiplex gel was safe but not proven to be effective, and therefore, not approvable. Did statistics get in the way of something that’s needed, works for some and is safe? Decide for yourself.

Tiger’s Knee and the Cruel Twist to the Sport of Golf
At the U.S. Open in June, Tiger Woods played through intense knee pain to stay on the leader board. His next appointment is with an orthopedic surgeon. Last year there were 103,000 golfing related orthopedic injuries reported. That’s $2.4 billion in medical care. For more on this important and growing market segment read on.

He’s renowned for his turnaround. By wending his way through organizational and management issues, over the years Alan Iftiniuk, (interim) Chief Operating Officer of SpineMark Corporation, has become known as the “go-to” guy for getting an organization back on the road to economy and efficiency.

Maybe that’s because his parents were so in tune with the importance of thrift. Says Iftiniuk, “I was born in Detroit and moved to the suburbs when I was 4 years old. It was a middle-class environment, with my dad supporting a wife and three children as a skilled worker at General Motors. Both of my parents were products of the Depression, so they were seasoned savers and actually put away enough to pay for all three of our college educations. It was a time, however, when different things were expected of women and men. When my sisters and I talk now we see that for them, my parents held college out as an option; with me it was when, not if.”

After attending both Wayne State University and Oakland University, Alan Iftiniuk had a variety of options. “My degree was a combination of history and political science, and my vision was to become a teacher or lawyer. I started out in Kalamazoo working for The Upjohn Company, which at the time had 70,000 employees worldwide. They had an executive development program whereby each year they chose 20 people from the company to enroll. It was quite selective, as you had to be nominated by the Division President. Here would be an almost guaranteed track to a Director position, with a significant raise and more responsibility. The other option they gave me was going to law school at Notre Dame and having it completely paid for. (They had a vision of my becoming a patent attorney.) I wasn’t interested in patent law, but I did have a two young babies and a mortgage to consider. I took the management track and became Director of North American Operations Support, a huge step for a 23-year-old.”

But one person can do only so much when the environment around him is changing. States Iftiniuk, “After I had been Director for two years, my mentor, David Cosgrove, retired from the company. New management came in, the company was going through a number of organizational issues, and was involved with lots of different businesses. It felt like the future was unsettling, so I considered my options. The next door to open was that of a management position at KPMG Peat Marwick in Chicago. It was a good fit as I was already familiar with various components of health care, and for more than three years there I had the opportunity to hone my turnaround skills.”

Those skills would be sharpened just in time for some heavy-duty challenges. Explains Iftiniuk, “My longtime friend Lloyd Dean called me and said that he had just become COO of Advocate Healthcare in Chicago. He said, ‘Look, why don’t you come with me? One of their hospitals has relaxed itself and is not meeting its full potential. You could turn them around.’ I went and absolutely loved it. I could see that my friend Lloyd had certain discernment skills when it came to seeing what was possible for an organization. Soon Lloyd was invited to become CEO of Catholic Healthcare West, a company that analysts the world over thought would soon be bankrupt. When Lloyd called me this time and said ‘Come to Catholic Healthcare,’ I thought he was insane. But Lloyd is a genius and is very persistent…so I accepted. Today Catholic Healthcare West is one of the most profitable healthcare organizations in the world. It is the largest not-for-profit west of the Mississippi with a total of 44 hospitals. I am pleased to have had something to do with its success.”

Alan Iftiniuk’s next move would come after considering snow and sand. “Although I was ready to return to Chicago after my San Francisco experience, an offer came in to become President and CEO of French Hospital Medical Center in San Luis Obispo (a Catholic Healthcare West facility). Weighing blistering snowstorms against a year-round 72-degree environment where we could live by the ocean, it was no contest. It was 2004 and the losses per year were approximately $3.5 million. I’m proud to report that last year we had over $4 million in profit. We created a not-for-profit foundation and in less than three months went out and raised more than $6 million to rebuild the cardiac capabilities of the hospital. The community bought into our vision and will thus soon have access to world-class facilities.”

As for his involvement with SpineMark, it all began because Iftiniuk had the backbone to ask for change. “In the 1990s when I was President and CEO for Good Shepherd Hospital outside of Chicago, I reviewed an old pro forma for a spine center of excellence. I called Marcia Rogers, President and CEO of SpineMark and said, ‘Please validate the pro forma.’ It turned out that the spine center had more potential than was evident in the pro forma. I asked her to assist in making this multidisciplinary center a reality and utilized her expertise in bringing the various parties to the table. Within one year of opening its doors, the NeuroSpine Center of Excellence had increased patient volumes to the point that additional operative and non-operative providers were recruited, and loss of market share had been reversed.”

Continues Iftiniuk, “It was obvious that SpineMark itself had an incredible amount of potential and a top-notch business plan. Part of the reason I accepted this position with the company was that it had identified a specific need within our culture, namely the chronic back and neck pain experienced by baby boomers. These areas are now the way cardiac was viewed ten years ago, i.e., the thing to focus on. SpineMark has a great management team, affiliations with wonderful organizations like the Texas Back Institute, and an Advisory Board that manages protocols. Despite having a full-time job running French Hospital, I take my vacation time to help SpineMark with operational expertise. Some days it’s so rewarding that it feels like a vacation itself.”

An example of Iftiniuk’s successful strategies? “When I came to SpineMark the Board gave me full access to all the company’s activities. I then did the same for the management team. This was in stark contrast to the era in which I grew up. That was a time when you had to be at a certain level to get certain information. My philosophy is to honor people with respect and information and show them they can be an important part of the team. I ensure that we executives spend as much time with non-management personnel as with management. In health care the margins are so small that we can’t afford to ‘carry’ people. This means that if you’re here, you’re important. Just like a good sports team, a star player can’t be successful in a vacuum. Take the great Kobe Bryant. Even he doesn’t go far without support.”

As for other management maxims, Iftiniuk sometimes turns to others. “To be a great leader you absolutely must be a great listener. If you aren’t you will rush to judgment, something that is expensive in many ways. When you’re spending other people’s money it’s particularly important to understand what the opportunities are. Sometimes they come from surprising places. I think it was Mark Twain who said, ‘Wisdom is one’s reward for years of listening.’ I have also found that being flexible makes for great teamwork. There are times when a leader must be a consensus builder, as in, ‘It’s not my idea, but let’s do it and let the other person grow.’ And occasionally one must be autocratic, such as when the building is on fire. The foremost issue is to understand what is the potential of the organization for meeting the corporate vision. Where most people get in trouble is failing to implement the vision. They don’t get people on board the train and at times let their egos get in the way. Essentially, they start to believe their own press. Successful leaders are successful because they have a qualified team that has worked hard collaboratively.”

And they excel at learning from their own mistakes. States Iftiniuk, “I make mistakes every day. A good leader learns more from his or her mistakes than from successes. I tell my staff, ‘You’ll never get into trouble by taking a risk and making mistakes as long as it’s legal, ethical, and moral…and you don’t repeat them.’”

Asked what he is proud of today, Iftiniuk notes, “We recently opened a healing garden at French Hospital in honor of a fallen firefighter in our community. Science has shown that a garden can help the healing process; we hope that it will reduce the stress of patients, families, and employees alike. It was entirely paid for by generous donations from those in our community.”

With fulfilling work and a rewarding family life, Alan Iftiniuk wakes up in a happy mood every day. “I get up at 4:30 a.m. every day to work out. My wife Cathleen gets credit for how our two beautiful daughters turned out. There’s Jennifer, who lives in Chicago, and Melissa here in San Luis Obispo. As for me, I play golf once in awhile, but I’m always unhappy with my game. There’s no time for a turnaround on golf, however, given my other numerous responsibilities.”

Alan Iftiniuk…efficient with companies, patient with people.