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Thread: Interesting news article

  1. #1
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    Interesting news article

    From today's Wall Street Journal (online edition)

    HEALTH INDUSTRY APRIL 13, 2011.

    Hospital Bars Surgeon From Operating Room

    Medical Board in Oregon Separately Investigates Doctor Who Stood Out for High Rate of Multiple Spinal Procedures.


    By JOHN CARREYROU And TOM MCGINTY

    A Portland, Ore., neurosurgeon who performed multiple spinal fusions on the same patients lost his operating privileges at the hospital where he did many of his surgeries and is under investigation by the Oregon Medical Board.

    Providence Portland Medical Center revoked Vishal James Makker's surgical privileges last week following a March 29 article in The Wall Street Journal that identified Dr. Makker as having the highest rate of multiple spinal-fusion surgeries among 3,407 surgeons who performed the procedure on 20 or more Medicare patients in 2008 and 2009.

    Dr. Makker's rate was nearly 10 times the national average, a Journal analysis of Medicare claims data showed. Dr. Makker, who operated on some of his patients' spines as many as seven times, last month denied wrongdoing and said he acted in the best interest of his patients.

    Oregon's medical board has also opened an investigation into Dr. Makker, according to two people familiar with the matter. One of these people was recently interviewed by board representatives and Federal Bureau of Investigation agents as part of the probe. The FBI didn't return a call for comment. Dr. Makker's lawyer declined to comment.

    The Oregon board forced Dr. Makker to undergo remedial training in 2006 for what it called unnecessary surgeries and for allegedly billing for procedures he didn't perform, but his status is listed as active on its website. A malpractice lawsuit—the ninth in less than seven years—was filed against Dr. Makker last week.

    A spokesman for Providence Portland declined to say why it withdrew his privileges.

    The latest developments came as new information emerged about the medical-device distributorship that supplies Dr. Makker with spinal implants. The distributor, Omega Solutions of Fresno, Calif., sometimes pays surgeons to use its products, according to a document reviewed by the Journal that Omega recently sent to surgeons it sought to recruit.

    The document says that the company enters into partnerships with surgeons who agree to use its products and pays them "dividends" based on the number of surgeries they perform. Critics say such arrangements are controversial because they can skew medical decision-making.

    The document details the cash payments made to one of Omega's partners, an unnamed spine surgeon in Los Angeles. From Jan. 1, 2009, to May 19, 2010, the surgeon received a total of $519,674.35 based on his use of Omega implants in two to three surgeries a week, the document says.

    Dr. Makker told colleagues at Providence Portland Medical Center that he was a partner in Omega's business, according to a person familiar with the matter. Through his lawyer, Dr. Makker denied this.

    Ted Switzer, the chief executive of Omega, said the company wasn't involved in a partnership with Dr. Makker that paid him to use its products, and declined to answer any other questions. Robert Zendejas, the Omega employee whose name is on the company's marketing document, hung up on a reporter when reached by phone.

    Physician-owned distributorships, or PODs, such as the ones outlined in the Omega document have spread through spine-surgery circles. Distributorships act as middlemen between medical-device makers and the hospitals and surgery centers that buy their products. In exchange for marketing the devices and nurturing client relationships, they get a cut of each sale.

    For a distributorship, winning the allegiance of surgeons is crucial because surgeons often dictate to their hospitals which devices to buy. By offering surgeons an ownership interest in their operations, distributorships can lock up a hospital's business while allowing the surgeon to profit from each device he uses, according to people familiar with how PODs function.

    Critics say such deals have contributed to a jump in spine surgeries. Spinal fusion, which involves fusing together two or more vertebrae with the help of thousands of dollars of hardware, went from costing Medicare $343 million in 1997 to $2.24 billion in 2008, according to a Journal analysis of Medicare claims data.

    The Office of Inspector General of the Department of Health and the Centers for Medicare and Medicaid Services have both warned that PODs may violate federal antikickback statutes and laws governing patient referrals.

    Mr. Switzer, the Omega Solutions CEO, is listed in California corporate records as a partner in a half-dozen limited liability companies named after letters in the Greek alphabet. Asked whether they are PODs, Mr. Switzer declined to comment.

    Dr. Makker's use of Omega implants raised eyebrows at Providence Portland Medical Center because Omega's product representative in Portland, Erin Martinson, is Dr. Makker's girlfriend, according to three people with knowledge of their relationship. Ms. Martinson was often present in the operating room with Dr. Makker to hand him the Omega implants during his surgeries there.

    Ms. Martinson didn't return phone calls. In an email last month, Dr. Makker denied having a romantic relationship with Ms. Martinson, saying she was merely a friend.

    Write to John Carreyrou at john.carreyrou@wsj.com and Tom McGinty at tom.mcginty@wsj.com

    Copyright 2011 Dow Jones & Company, Inc.

  2. #2
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    There is a known problem with overuse of spinal fusion surgery for non-scoliosis conditions. This is almost certainly what is going on with Makker.

    This doesn't apply to fusion for scoliosis. People with scoliosis who need surgery get it and people who don't don't. This is largely true for adults and nearly completely true for kids. There is no unnecessary fusion for scoliosis so the issue with Makker is interesting though irrelevant here.

    Whether a surgeon uses instrumentation A versus instrumentation B is not a pertinent question if the patient needs instrumentation and both instrumentation sets solve the problem.

    The fact that some surgeons might make money on certain instrumentation doesn't majick away the need of the patient for the fusion for scoliosis.
    Sharon, mother of identical twin girls with scoliosis

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  3. #3
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    I clicked on the article, read 'hospital bans surgeon from operating room' 'scoliosis' 'Portland Oregon' and my heart sank. Never read an article so fast in my life, lol.
    Son 14 y/o diagnosed January 20th. 2011 with 110* Curve
    Halo Traction & 1st. surgery on March 22nd. 2011
    Spinal Fusion on April 19th. 2011

    Dr. Krajbich @ Shriners Childrens Hospital, Portland Oregon



    http://tinyurl.com/Elias-Before
    http://tinyurl.com/Elias-After

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    Quote Originally Posted by Elisa View Post
    I clicked on the article, read 'hospital bans surgeon from operating room' 'scoliosis' 'Portland Oregon' and my heart sank. Never read an article so fast in my life, lol.
    I'm confused.

    What did you click? The only clickable thing in the OP was the authors email addies.

    Where do you see the word, "scoliosis" anywhere in this article? This article is NOT about scoliosis fusions and in fact is not relevant to them.
    Last edited by Pooka1; 04-14-2011 at 10:31 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  5. #5
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    You're right Pooka, no mention of scoliosis, it was "spinal fusion" that caught my eye as well as "Hospital Bars Surgeon From Operating Room" and "Portland, Oregon".
    Son 14 y/o diagnosed January 20th. 2011 with 110* Curve
    Halo Traction & 1st. surgery on March 22nd. 2011
    Spinal Fusion on April 19th. 2011

    Dr. Krajbich @ Shriners Childrens Hospital, Portland Oregon



    http://tinyurl.com/Elias-Before
    http://tinyurl.com/Elias-After

  6. #6
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    Quote Originally Posted by Elisa View Post
    You're right Pooka, no mention of scoliosis, it was "spinal fusion" that caught my eye as well as "Hospital Bars Surgeon From Operating Room" and "Portland, Oregon".
    Linda can correct me if I'm wrong but I think the vast majority of spinal fusions are done for back pain or other orthopedic issues not to include scoliosis. They are NOT done for scoliosis.

    The main problem is that, as I understand it, this majority of spinal fusions done for back pain apart from scoliosis cases do NOT result in less pain afterwards. So it's a boondoogle basically and ripe for moral turpitude like that in the article.

    This is exactly the opposite situation for spinal fusions for scoliosis where most people end up with less pain afterwards. Many end up with no pain.

    That's why this article is irrelevant to scoliosis. If a person needs fusion to treat scoliosis, it is simply irrelevant if the surgeon is making little or lots of money using one set of instrumentation instead of another assuming both sets will treat the patient equally well. That's a matter for the insurance companies to hash out, not the patients who need the fusions.

    The bottom line is there is no evidence that people with scoliosis get unnecessary fusions. Rather it is the opposite... some people who could be helped by fusion don't avail themselves of it. The number of cases of diagnosed kids who need fusion for AIS who DON'T get it are vanishing and largely limited to folks with no access to medical care I imagine.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  7. #7
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    When I fist skimmed the article and saw that a surgeon who did spinal fusions in Portland, Oregon was banned from a hospital my heart did give a skip b/c obviously I am here in Portland waiting for my son to have spinal surgery on Tuesday so I'm a bit jumpy and certainly didn't want to see Dr. K's name on there, heh.

    Okay, now that hdugger has brought up the price of screws, I have been very curious to know just how much do you guys figure these rods and screws etc. actually cost. I have read on other posts that they are VERY expensive but would like more of a ballpark figure as to what they actually cost: $500? 5K? more?
    Son 14 y/o diagnosed January 20th. 2011 with 110* Curve
    Halo Traction & 1st. surgery on March 22nd. 2011
    Spinal Fusion on April 19th. 2011

    Dr. Krajbich @ Shriners Childrens Hospital, Portland Oregon



    http://tinyurl.com/Elias-Before
    http://tinyurl.com/Elias-After

  8. #8
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    Quote Originally Posted by Elisa View Post
    When I fist skimmed the article and saw that a surgeon who did spinal fusions in Portland, Oregon was banned from a hospital my heart did give a skip b/c obviously I am here in Portland waiting for my son to have spinal surgery on Tuesday so I'm a bit jumpy and certainly didn't want to see Dr. K's name on there, heh.

    Okay, now that hdugger has brought up the price of screws, I have been very curious to know just how much do you guys figure these rods and screws etc. actually cost. I have read on other posts that they are VERY expensive but would like more of a ballpark figure as to what they actually cost: $500? 5K? more?
    Linda will know but I think it's on the order of $30K or more for a "typical" scoli fusion.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #9
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    Quote Originally Posted by Pooka1 View Post
    Linda will know but I think it's on the order of $30K or more for a "typical" scoli fusion.
    That is about the number that I read a while back. I was talking to my sister the other day on the phone and I was telling her about how expensive the surgery was as well as how expensive the hardware was and she joking said: "Well I guess that's why they never took Elias on at BC Children's".

    So, if he has 8 screws in him so far... he has a pretty expensive back already. ;-)
    Son 14 y/o diagnosed January 20th. 2011 with 110* Curve
    Halo Traction & 1st. surgery on March 22nd. 2011
    Spinal Fusion on April 19th. 2011

    Dr. Krajbich @ Shriners Childrens Hospital, Portland Oregon



    http://tinyurl.com/Elias-Before
    http://tinyurl.com/Elias-After

  10. #10
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    Quote Originally Posted by Elisa View Post
    That is about the number that I read a while back. I was talking to my sister the other day on the phone and I was telling her about how expensive the surgery was as well as how expensive the hardware was and she joking said: "Well I guess that's why they never took Elias on at BC Children's".

    So, if he has 8 screws in him so far... he has a pretty expensive back already. ;-)
    Both my kids have a 10 level fusion with about 15 screws and about 2 hooks iirc. There is at least one cross member on each construct. It's been a while but I seem to recall the instrumentation cost on the first kid (March 2008) as being about $18K. I could be wrong. The entire thing including instrumentation came to about $75K for the first kid. I am guessing it was the same for the second.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  11. #11
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    Quote Originally Posted by Pooka1 View Post
    Linda can correct me if I'm wrong but I think the vast majority of spinal fusions are done for back pain or other orthopedic issues not to include scoliosis. They are NOT done for scoliosis.

    The main problem is that, as I understand it, this majority of spinal fusions done for back pain apart from scoliosis cases do NOT result in less pain afterwards. So it's a boondoogle basically and ripe for moral turpitude like that in the article.

    This is exactly the opposite situation for spinal fusions for scoliosis where most people end up with less pain afterwards. Many end up with no pain.

    That's why this article is irrelevant to scoliosis. If a person needs fusion to treat scoliosis, it is simply irrelevant if the surgeon is making little or lots of money using one set of instrumentation instead of another assuming both sets will treat the patient equally well. That's a matter for the insurance companies to hash out, not the patients who need the fusions.

    The bottom line is there is no evidence that people with scoliosis get unnecessary fusions. Rather it is the opposite... some people who could be helped by fusion don't avail themselves of it. The number of cases of diagnosed kids who need fusion for AIS who DON'T get it are vanishing and largely limited to folks with no access to medical care I imagine.
    Since my involvement has always been with spinal deformity surgeons, my only experience with these other surgeons is from what I read. My understanding is that there are a lot of surgeons who take almost every back pain patient to fusion surgery. It's a highly effective surgery, but is unneeded in a large percentage of patients who see this type of surgeon. And, if the surgeon is using an implant for which s/he receives some sort of royalty, the profit can be huge.

    On the subject of surgeons designing and manufacturing implants, the debate isn't an easy one. If we had to depend on non-surgeons to design implants, we would not be nearly as far along in terms of the technology of spinal surgery, especially in terms of spinal deformities. I really hate insurance companies, but this is one time where they have the potential to do a lot of good. I can't imagine how they let Makker get away with what he did.

    I don't know much about the cost of the implants any more, but $5,000 per screw (especially if it's titanium or one of the other more recent technology metals), sounds about right.

    Regards,
    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  12. #12
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    Here's a recent study regarding AIS patients (includes total cost, not just instrumentation). Adult and revision surgeries would probably be much more expensive.


    Cost Varies by Region in Spinal Fusion for Scoliosis

    Per-patient average charge ranges from $103,256 to $152,637; length of stay also varies

    Scott D. Daffner, M.D., of West Virginia University in Morgantown, and colleagues extracted records from a national insurance billing database on 76,741 idiopathic scoliosis patients (aged 10 to 24), 955 of whom underwent fusion surgery during 2004 to 2006.

    Overall, the researchers found that the per-patient average charge (PPAC) for the procedure was $113,303 with an average LOS of 5.6 days. PPAC varied by region, with the West highest at $152,637 and the South lowest at $103,256. LOS was lowest in the South (5.2 days) and highest in the Midwest (6.5 days).

    http://www.modernmedicine.com/modern.../detail/672724

  13. #13
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    Quote Originally Posted by Ballet Mom View Post
    Here's a recent study regarding AIS patients (includes total cost, not just instrumentation). Adult and revision surgeries would probably be much more expensive.


    Cost Varies by Region in Spinal Fusion for Scoliosis

    Per-patient average charge ranges from $103,256 to $152,637; length of stay also varies

    Scott D. Daffner, M.D., of West Virginia University in Morgantown, and colleagues extracted records from a national insurance billing database on 76,741 idiopathic scoliosis patients (aged 10 to 24), 955 of whom underwent fusion surgery during 2004 to 2006.

    Overall, the researchers found that the per-patient average charge (PPAC) for the procedure was $113,303 with an average LOS of 5.6 days. PPAC varied by region, with the West highest at $152,637 and the South lowest at $103,256. LOS was lowest in the South (5.2 days) and highest in the Midwest (6.5 days).

    http://www.modernmedicine.com/modern.../detail/672724
    These numbers include hospitalization and surgeon fees, so there's no way to know what the cost of the implants is.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  14. #14
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    Quote Originally Posted by Elisa View Post
    That is about the number that I read a while back. I was talking to my sister the other day on the phone and I was telling her about how expensive the surgery was as well as how expensive the hardware was and she joking said: "Well I guess that's why they never took Elias on at BC Children's".

    So, if he has 8 screws in him so far... he has a pretty expensive back already. ;-)
    I'm sure the cost of your son's stay is much greater than the average scoliosis surgery due to the halo treatment and length of stay. Your son is receiving donated care that most kids with those size curves do not receive. The girl water polo player that I mentioned that had a 112+ degree curve after waiting to play in her state finals had just a regular scoliosis surgery, with no halo treatment, etc. The surgeon recalls the surgery as "very difficult" as he had to move that large curve in one big session. Kids from this country do not receive insurance payments to stay for weeks at the hospital with a halo on. That seems to be a Shriners feature.

    I'm sure that's why you received the response you did from the surgeon you don't care for. It's not like you're going to be given a choice of instrumentation should you not like the set being provided.

    I'm just glad there are kind old men willing to provide money for the wonderful treatment these kids receive with these conditions, without knowing them, and from countries that like to say they have universal care. God bless them.

  15. #15
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    Quote Originally Posted by LindaRacine View Post
    These numbers include hospitalization and surgeon fees, so there's no way to know what the cost of the implants is.
    Yes, I deliberately stated that the study included total costs, not just instrumentation. People were quoting total costs, so I added to the conversation.

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