The North American Spine Society (NASS) just held its 25th birthday party in Orlando.
The biggest, smallest and newest players from the spine community were all there. Medtronic, DePuy, Synthes…wait, where was Synthes? The third largest kid on the spine block was nowhere to be found in the exhibit hall.
Coming on the heels of Medtronic Chairman Bill Hawkins’ announcement that spine surgeons’ influence is waning, we wondered if Synthes’ conspicuous absence was a sign of the times and a wake up call for NASS.
Synthes’ Conspicuous Absence
“Why weren’t you at the meeting?” we asked, via email, Synthes’ spokesperson Gilgian Eisner (no relation to this writer).
Eisner told us that the company’s products do not really sell at the conference exhibition but are sold through the sales force in hospitals and operating rooms.
“After conferring with society leadership on the best way to support NASS, we decided to opt out of the exhibit hall for 2010, and to provide a substantial increase in society managed financial support.”
Synthes continues to discuss the company’s role in future meetings with medical societies. Eisner said the general consensus is that the societies preferred to receive less financial support, and to keep Synthes as an exhibitor. He said many of the societies feel strongly that the exhibit hall is a vital component of the overall conference experience for each attendee.
Eisner added,
So beginning in 2011, we will return to the exhibit hall, but with a renewed focus on improving the exhibit hall experience for each meeting attendee.
Eric Muehlbauer, NASS’ Executive Director agrees. Muehlbauer told OTW that he gives Synthes credit for trying something new and looks forward to seeing the company back on the exhibit floor in Chicago.
NASS’ Eric Muehlbauer
Courtesy NASS, Levar CooperMuehlbauer told us that NASS provides a forum and marketplace for device companies at the annual meeting and the marketplace takes its own course. In Orlando over 3, 500 attendees showed up, with an additional 3, 700 industry representatives. “We had more exhibitors than ever, ” said Muehlbauer.
Not everyone at the birthday party was singing Happy Birthday.
Wall Street: “Macro Pressures & Desperate Measures”
Canaccord Genuity’s device analyst Bill Plovanic* summarized the meeting for his clients with the headline: “Macro Pressures & Desperate Measures.” He said the impact of macro pressures was “glaringly noticeable at the meeting.”
Bill Plovanic
photo courtesy of
CANACCORD/Genuity“Over the next few years, we expect to see a decreasing number of company exhibitors and surgeons in attendance as several surgeons we spoke with found very little value-add in the meeting and appear to be looking at alternative spine conferences for the future.”
“Overall, the meeting presented a range of emotions associated with grief, including denial, anger, bargaining and depression (but no acceptance). We expect Darwin’s theory to play out for both implant manufacturers and surgeons, as sweeping change will provide both opportunities and challenges in the dynamic spine industry.”
NASS Defends Meeting
Besides noting a record number of exhibitors, Muehlbauer reminded us that there is a waiting list of companies that want to be on the exhibit floor. “If we wanted to, we could have an even larger trade show, ” added Muehlbauer, “but that’s not our goal. Our goal is to try to keep the attendee to exhibitor ratio as close to 1 to 1 as we can.”
It’s also worth noting that since the last NASS meeting, the society added a record number of nearly 700 new members to the ranks.
Being a specialized society is an advantage during difficult economic times, according to Muehlbauer. As marketing budgets tighten for manufacturers, the ability to “rifle-shot” their message to a highly specialized audience is more cost effective than a “shotgun” approach.
But back to the meeting.
Plovanic cited several key take ways from the meeting, including:
- The increased offering of lateral access fusion approaches and an improved outlook for cervical discs.
- Clarity from surgeons on the payer pushback that is making it more arduous to prove medical necessity for spinal procedures.
- Surgeons’ conversations are becoming more financially weighted as it relates to pricing.
- Vertebroplasty and kyphoplasty remain on the brink and he believes a blanket CMS (Centers for Medicare and Medicaid Services) noncoverage decision is possible.
- Physician-owned distributorships (PODs) are another trend proliferating in a market where some surgeons are looking to supplement declining incomes.
Baker’s “State of Spine”
In his farewell speech, outgoing NASS President Ray Baker, M.D., said society policies in ethics, professionalism, and health policy are now yielding dividends. “Payers and regulators, in particular, are taking notice. Amongst spine care professionals across North America and abroad; NASS is increasingly seen as THE reasonable and credible voice for spine care.”
Ray Baker, M.D., /Photo Courtesy NASS, Levar Cooper
Baker, a pain specialist, was not in denial of the changing environment.
“No one can deny that the challenges we face are very real. I know that many of us, at times, feel like Woody Allen when he said, ‘One path leads to despair and utter hopelessness. The other, to total extinction. Let us hope that we have the wisdom to choose correctly.’”
“We are in the midst of the worst economic downturn this country has faced since the great depression. We have endured the glare of intense public scrutiny with heightened rhetoric leading up to passage of health care reform legislation. We now face the uncertainty of defining and implementing those unprecedented changes. Meanwhile, we watch as our reimbursements continue to spiral downward, tort reform is taken off the national agenda, and the SGR (sustainable growth rate) formula goes unaddressed.”
Physician Solidarity
In perhaps a veiled reference to the apparent disagreement with AAOS (American Academy of Orthopaedic Surgeons) over vertebroplasty and kyphoplasty, Baker cautioned:
“There are many forces trying to divide us today. Coding and reimbursement remain a zero sum game—when one party wins another must lose. Scope of practice issues loom large on the horizon. Yet, as lines blur between and among specialties, we must remain united.”
He noted that 11 major societies recently held their second Spine Summit at NASS.
“I’m encouraged that the coalition of societies placed working together on common coding and reimbursement issues at the top of their action item list for the coming year.”
Changing Economics
In his most pointed comments about the changing economic landscape for physicians, he cited Dr. Atul Gawande’s New Yorker article about the vastly different per capita Medicare expenditures between the Texas communities of McAllen and El Paso.
In 2006, McAllen’s Medicare expenditures were twice that of El Paso’s even while having lower quality ratings. In 1992, the costs per patient were identical. “What happened?” asked Baker
He quotes Gawande:
“About fifteen years ago…something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So…a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.”
Baker urged his colleagues to take heart and look at the big picture.
“When I first entered practice, senior colleagues complained that the golden age of medicine had just passed. Medicine was going to hell in a hand basket. Now, two decades later, I hear my contemporaries saying the same thing. It appears to me that the definition of ‘the golden age of medicine’ is the era ending precisely when you begin practice. But in reality, medicine, like everything else, is in a continual state of change and evolution. Change is, at times, unsettling, but change is also inevitable.”
Impact of Quality-Based Health Care
Plovanic’s view was a bit more granular.
He said the meeting marked the beginning of the transition to a quality-based [health care] system from a volume-based one and will have “no impact for the average surgeon, but a major negative for the high volume ‘engaged’ surgeon.”
“Compared to other surgical specialties, spine surgeons have been living like rock stars. With favorable reimbursement, hoards of sales reps available to service their every need, and consulting agreements as ubiquitous as ATM machines, doctors have been very happy.”
Plovanic says he believes that this year’s NASS meeting was a wake-up call for all spine surgeons.
“For those physicians who are happy to be employees of the hospital, have no affiliations with companies…we feel the changes will be bearable. However, for the high-volume, top recognized, seven-figure surgeon in a private practice with strong corporate ties, we feel the changes are going to be devastating.”
Plovanic writes that the days of device companies growing their sales through consulting agreements for performing studies or designing a new product will soon change.
What will likely become the norm, predicts Plovanic, is that the development of procedures or products that improve outcomes, reduce trauma to the patient and/or hospital stays, or speed up a surgical procedure will be the main drivers for adoption of new technologies.
Birthday Party in 2011
We suspect the exhibit floor for NASS’ 26th meeting will look very much like this year’s, with the addition of Synthes. What will likely change, as companies execute new marketing strategies, will be how attendees are engaged by the exhibitors and by their society.
Birthday parties grow up.
* Canaccord Genuity asks OTW to include a conflict of interest disclosure document as it relates to their role as a broker/dealer. Click here.
