Bucking Conventional Wisdom With SI Fusion
It is human nature to find something that works and stick with it…even when it begins to lose its luster. “There are times when I have proposed an alternative way of doing things and people have said, ‘Well, this is how we do it in orthopedics.’ I ignore that kind of thinking and forge ahead with something unique and workable.”
“When people said that building a company around the SI joint was ‘nonsense’ we proved them wrong. When our detractors exclaimed, ‘You will never get exclusive reimbursement from payors’ we got 35 U.S. payors on board.”
What is Jeff Dunn’s magic wand?
Data.
“We were able to convince payors that our extensive clinical evidence shows that we deserve exclusive coverage. We have 78 peer reviewed published papers and competitors don’t even have one randomized controlled trial. That is the same in France and in the UK, where NICE [National Institute for Health and Care Excellence] has stated that only our product should be used in SI joint fusion.”
“Most people view reimbursement in orthopedics as a big negative. We turned that upside down and made it into a competitive advantage. I believed that payors were tired of covering things that didn’t work or had little clinical evidence. Things were evolving such that payors only wanted to cover things that are ‘good’…and that means things that work, work quickly, and are durable so they will not have to pay again.”
“We went to payors and said, ‘What exactly is important to you?’ They want products and procedures that have low revision rates, reduce opioid consumption, and make economic sense. I said, ‘We have studies showing that our product reduces pain rapidly and durably, reduces opioid use, etc.’”
“It was clear that we had differentiated ourselves from a product and evidence standpoint. On January 1, 2018 we obtained our most significant exclusive payor win when the Blue Cross Blue Shield Association [BCBSA] which is the franchisor to all the Blues, recommended positive coverage for SI joint fusion only when performed with our product. Most of the Blues followed the recommendation of BCBSA.”
Describing the SI-BONE brand as, “A unique product backed up by robust clinical evidence,” Jeff Dunn stated, “Over my years as a CEO the saying has been, ‘Data counts, opinions don’t matter.’ When data is good, we use it to drive a strategic agenda. And when the naysayers stated, ‘You can’t get the facility payments increased,’ we were able to do just that, with outpatient reimbursements increased 40% and Ambulatory Surgery Center reimbursements increased 60% effective January 1, 2017.”
