Dear OTW Reader:
Industry reshaping itself into three big players? East Coast not gotten the message about metal on metal? MedPAC doing a “divide and conquer” of doctors? Oh, and what execs are going where…read on…
Acquisition Frenzy?
An industry insider tells OTW, “A lot of people are keeping a close eye on how the orthopedic market is reshaping itself through acquisitions. Large companies are sitting on piles of cash and investors want them to put that money to work. It seems that the timing is right for the industry to reshape itself to three big players…J&J and Stryker have made a number of acquisitions lately; Zimmer will likely do the same. And, when you look at how the market has matured you can see that it has become more of a distribution play (as opposed to innovation). If you have any doubt, just look at manufacturers in other specialties; cardiology is now controlled by three companies. Ultimately, I think this is good for all parties…for example, you don’t have surgeons in one hospital system clamoring for numerous implant systems—and often, as with knee systems, it is hard to find any real difference between them anyway.”
East Coast Lagging Behind Re: Metal on Metal?
An orthopedist tells OTW, “There are a lot of centers that did scores of metal on metal implants that—at first—looked good. The problem now is that there are these waves of popularity traveling across the country…I’ve seen that it often means that the East Coast lags behind…people haven’t really gotten the message that these are not a good idea. Those surgeons who have not been exposed to the results of research are more likely to continue putting them in because they don’t know not to. Getting the message out is proving to be an issue.”
Michael Harrer, M.D. Joins Rothman
Michael F. Harrer, M.D., is the newest joint surgeon at the Rothman Institute in Philadelphia, Pennsylvania. Dr. Harrer received an AB in biology from Princeton University, and while there also made time for varsity football. Dr. Harrer, who was previously Joint Director at Our Lady of Lourdes in Camden, New Jersey, earned his medical degree from Jefferson Medical College in Philadelphia. He completed his orthopedic surgical residency at UMDNJ Robert Wood Johnson University Hospital in New Brunswick, New Jersey, and did an adult reconstruction fellowship at Anderson Orthopaedic Clinic in Mount Vernon, Virginia.
Congress Cutting Specialists’ Pay?
An orthopedic surgeon who has his ear to the ground on Capitol Hill tells OTW, “MedPAC just released a new SGR (Sustained Growth Rate) ‘fix’ that will significantly impact orthopedic surgeons. Included are calls for substantial cuts to specialists’ reimbursement, while holding primary care physicians reimbursement at current levels. I had a private conversation with someone on ‘the Hill’ who told me that Democrats and Republicans alike recognize the failure of the SGR, but a fix of any type is challenging, especially in the current economic climate. Historically, the MedPAC recommendations have not widely been enacted, largely due to political struggles. This is one of the impetuses for creation of the widely unpopular Independent Payment Advisory Board—however, many providers fear arbitrary cuts with minimal Congressional oversight will have detrimental impact on patient care. Furthermore, MedPAC’s SGR fix has potentially severe negative impact on access to orthopedic care and may further divide the physician community—theirs is the only fix that preferentially cuts specialist reimbursement. Aren’t we already divided enough? Competing interests often are represented by one powerful lobby on the Hill, while there are over 200 medical and patient advocacy groups!”
Health Affairs Brouhaha
It’s a beehive of anger and angst, says an orthopedic insider about a recent Health Affairs story stating that the salaries of orthopedic surgeons and family doctors are more than any other physicians in the country. This individual tells OTW, “Orthopedists are naturally concerned about their image…not to mention that this could be used as another excuse to cut reimbursements. “Ridiculous” and “unfair” and “grossly inaccurate” are some of the things I’ve heard about the study. People are concerned about the validity of the study…for example, it didn’t take into consideration the amount of hours doctors work or the volume of procedures done (which is usually more than in other countries).”
Greg Sasso Joins Biotronic
And the new president and CEO is…Greg Sasso. Sasso was most recently the senior vice president and president of Biomet International, Biomet Sports Medicine and Biomet Microfixation. In his 26 years at Biomet Sasso was one of the key members of the M&A team that led Biomet’s going-private transaction by a private equity consortium that consisted of Blackstone, Goldman Sachs, TPG and KKR for $11.7 Billion in 2007.
A World First
Kaye Wilkins, M.D., tells OTW, “I recently returned from the first-ever pediatric orthopedic meeting in Nepal. The specialty is just starting out there, and they have yet to separate pediatric orthopedics into a separate discipline. At present there is no training for pediatric orthopedists there, so they have to train abroad. The major issues? Chronic, untreated fractures and infections…they are where the U.S. was 50 years ago, so progress will be slow. I hope to help out by facilitating a POSNA [Pediatric Orthopaedic Society of North America] scholarship for at least one orthopedic surgeon—that way they can come here and learn useful techniques for use at home.”
Novel Test for Infection
Carl Deirmengian, M.D., an orthopedic surgeon at the Rothman Institute in Philadelphia, has developed a unique test for infected hip and knee replacements. Dr. Deirmengian tells OTW, “I ran several clinical studies on the cloudy fluid that is generated when a joint gets inflamed. There have never been any FDA approved tests for synovial fluid…we have only had subjective lab tests (like someone counting cells or running a culture). So I looked at the genetics of the cells in the fluid, and found that the body responds uniquely to different joint diseases. Our key discovery is that the synovial fluid has unique biomarkers, which are a result of the specific white blood cell response to infection. What is critical, of course, is that the biomarkers in the joint fluid have a higher accuracy than blood tests. We published this work in Clinical Orthopaedics and Related Research last year and we were also honored to win the Coventry Award from the Knee Society for this research in the past. CD Diagnostics was formed to develop the point-of-care rapid immunoassay for infection, and our CEO Rick Birkmeyer has been quite successful in advancing toward our goals. We have already secured $1.5 million in angel funding. Currently, we are exploring partnerships with different companies and anticipate significant growth in the near future.”
ORS Increasing Clinical Focus
Ted Miclau, M.D., the next president of the Orthopaedic Research Society (ORS), tells OTW, “Scientific technology has become so much more sophisticated in a relatively short period of time. In the ORS Annual Meetings, the growth of the biological and engineering fields has been clearly apparent, although there has not been as much expansion in the translational clinical research presented…so, we are trying to more fully develop clinical research in the ORS. Last year we held the first Clinical Research Forum, which was a first step in developing a home for clinical research, and provided a venue for clinical researchers, basic researchers, industry members, and individuals from funding and regulatory agencies to interact with each other. This year, the event will provide for a similar opportunity. The goal will be to provide an overview of key types of research involved in bringing products to market, and through the evaluation of controversial areas such as metal-on-metal, bisphosphonate-related femur fractures, and BMP usage, determine how we might do things better in the future.”
Closer to “Holy Grail” of Articular Cartilage
Dr. Paul Saluan, an orthopedic surgeon at Cleveland Clinic, is the Principal Investigator on a novel study involving articular cartilage reconstruction. He tells OTW, “We are just starting out on this three-four year investigation, and we are getting closer to the ‘Holy Grail’ of being able to get type two collagen where it belongs…trying to get back the articular cartilage instead of scar tissue. This is one of the most common issues that sports medicine specialists deal with—everything we do is geared toward maintaining normal joint function. To do that you must have normal load bearing. Once the patient loses articular cartilage and gets advanced arthritis then you are out of the realm of sports medicine and into total joint surgery. Our work involves articular cartilage allograft, and the early results are very promising. What we’re doing involves a one stage process as opposed to a two stage process (as it is now). Also positive is that there is ample allograft. The tissue engineering issue is such that there will be widespread availability.”
$2.6 Million for Rick Wright, M.D.
Rick Wright, M.D., co-chief of Washington University’s Sports Medicine Service, has just been awarded a $2.6 million grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health. He is heading up the MARS study (Mutlicenter ACL Revision Study), which is comparing surgical techniques and analyzing outcomes for patients undergoing ACL surgery. The goal? To learn why a subsequent reconstruction is more likely to fail than an initial ACL repair.
