Friday, November 9, 2012

Loveland's Spine Institute to Build Surgery Center

New 15,000-square-foot facility will open next summer in Johnstown's 2534 development

By Craig Young, Reporter-Herald Staff Writer           Read the original story in the Loveland Reporter-Herald

A Loveland medical clinic specializing in spine surgery and research has bought land for a new surgery center in Johnstown.

The Spine Institute at Rocky Mountain Associates in Orthopedic Medicine purchased property in the 2534 development southeast of the Interstate 25-U.S. 34 interchange. The 1.8 acres sold Oct. 16 for $385,000.

The company moved its office to a building in 2534 a month ago, according to practice manager Dee Goodman, and then bought the adjacent property for its new Spine and Orthopedic Surgery Center.

"Our goal is to be breaking ground soon," she said, with plans to open the surgery center in July 2013.

"We'll be specializing in research, pain management, spine surgeries and biologics (adult stem cell treatments)," she said.

The nearly 15,000-square-foot surgery center will have three operating rooms and six convalescent rooms allowing patients to stay up to 72 hours after surgery, Goodman said.

Drs. Kenneth Pettine and Jeffrey Donner formed Rocky Mountain Associates in Orthopedic Medicine in 1991 and the Spine Institute in 2004. The practice recently moved from North Grant Avenue in Loveland to 4795 Larimer Parkway in the 2534 development.

Rocky Mountain Associates employs about 25 people, including six physicians, according to Goodman, and plans to add another doctor in the near future.

The practice's owners speak nationally and internationally on innovative noninvasive spine technologies, according to the company's website, and Pettine is the co-inventor of an artificial replacement disc.

Goodman said the company chose the 2534 location because of the growth occurring there and the easy access to the interstate. "We have patients who come from all over," she said, including Denver, Colorado Springs, Wyoming and other states.

"They've heard of our spine surgeons and that they specialize in different spine cases," she said, "and we're involved in several different research studies."

The Spine Institute's new locations are directly south of Northern Colorado Long Term Acute Hospital, Northern Colorado Rehabilitation Hospital and Gonyon Cosmetic and Plastic Surgery and about a mile east of the new Kaiser Permanente clinic.

Ryan Schaefer, president of Chrisland Commercial Real Estate, which represented the seller of the land to the Spine Institute, said developers in 2534 have a goal of attracting medical facilities.

"Once the rehab hospital located there, that really created a catalyst for other medical practices to locate there," he said.

He said the Spine Institute's move to 2534 is indicative of the resurgence in the commercial and residential real estate industry that's taking hold in Northern Colorado.

"We're starting to see a rebound," Schaefer said. "It's fairly widespread."

He said the 542-acre 2534 development also is attracting the attention of retailers and primary employers, and he predicted being able to make announcements by the middle of next year.

Craig Young can be reached at 635-3634 or cyoung@reporter-herald.com. Follow him on Twitter: @CraigYoungRH.

Thursday, November 1, 2012

The coflex® Device Receives FDA Premarket Approval


Note: The Spine Institute participated in the coflex® study and Dr. Pettine backs its ability to help patients with moderate to severe spinal stenosis. To learn more about coflex®, please contact us.

Paradigm Spine Announces U.S. FDA PMA Approval of its Landmark coflex® Interlaminar Technology:
The First Comparative Effectiveness Study for the Treatment of Spinal Stenosis


Read this story online

New York, NY, October 17, 2012 - Paradigm Spine LLC, a provider of innovative spinal implant technologies, announces the U.S. Food and Drug Administration (“FDA”) has granted a Premarket Approval (“PMA”) Order for coflex®, a minimally invasive, Motion Preserving Interlaminar Stabilization™ device for the treatment of Moderate To Severe Stenosis With Or Without Back Pain™.

Key Points:

  • First PMA for the treatment of Moderate To Severe Stenosis With Or Without Back Pain™
  • First prospectively randomized comparative effectiveness Investigational Device Exemption (IDE) study that evaluated pedicle screw fusion following surgical decompression, the current standard of care for the treatment of moderate to severe spinal stenosis, as the control. This study is unique in spine because it prospectively collected Level 1 clinical, radiographic, safety and healthcare economic data. The coflex® device demonstrated better or equivalent outcomes in all major primary and secondary endpoints.
  • The coflex® patients spent 40% less time in the hospital compared to fusion (1.90 vs. 3.19 days), and coflex® surgeries were 36% faster compared to fusion (98 vs. 153 minutes)
  • At 2 years follow-up, 85.8% of coflex® patients showed clinically significant improvement in pain and function (measured by Oswestry Disability Index), compared to 76.7% of fusion patients
  • At 2 years follow-up, coflex® patients retained their pre-operative range of motion (within 10%) and translation (within 5%) at the treated level and maintained normal adjacent level motion. In contrast, fusion patients experience 62% motion reduction at the treated level, and 52% increase in range of motion at the superior adjacent level.
  • First PMA to collect healthcare economic data for spinal stenosis. The study data and resulting analyses demonstrate that coflex® saves the healthcare system an average of $5,000 to $8,700 per case when used as an alternative to pedicle screw fusion1.
  • The coflex® study included a significant Medicare-aged patient population.
  • The coflex® device, now available in the United States, has more than 18 years of clinical history with regulatory approval in over 40 countries throughout 6 continents.

The coflex® clinical trial supporting the PMA represents the most comprehensive Level 1 comparative effectiveness study for the treatment of spinal stenosis. The rigorous six year clinical trial proves coflex® as the first and only motion-preserving alternative to fusion for the treatment of moderate to severe spinal stenosis, by demonstrating better or equivalent outcomes in all major primary and secondary clinical and radiologic assessments, while maintaining natural motion at both treated and adjacent spinal levels. The study results are based on data evaluated from 322 patients, at 21 sites throughout the United States, who presented with a history of spinal stenosis that failed over 6 months of conservative therapy. The patients enrolled in the study were prospectively randomized to receive a surgical decompression and either coflex® Interlaminar Stabilization™ or pedicle screw fusion. The coflex® device outperformed fusion in nearly all clinical, radiographic, and perioperative outcomes, supplemented with healthcare economic data measured through 589 data points evaluated for each individual study subject over a 2 year follow-up period. The data compiled for this study comprised more than 55,000 patient-completed case report form pages, more than 375,000 clinical and radiographic data points, more than 12,000 patient x-rays and prospective health insurance, reimbursement payment and claims data. The rigor of the clinical trial and the robustness of its results are supported by over a 95% follow-up through two years postoperatively, among the highest follow-up rate for any PMA approved device in spine.

According to a Wall Street Journal analysis of data compiled by the Centers for Medicare & Medicaid Services, it is estimated that fusion costs the United States government Medicare system more than $2.2 billion annually2. The coflex® study is the first and only to quantify actual cost savings based on prospective Level 1 data, compared to the current standard of care, posterolateral fusion. On average, coflex® saved $5,000 to $8,700 per case compared to fusion1. These substantial cost savings were achieved through significantly shorter operating room time, faster patient recovery, less blood loss, less narcotics usage by patients, and shorter hospital stay, while producing faster and more sustained clinically successful outcomes as compared to fusion in the treatment of spinal stenosis.

The PMA process is the most stringent FDA regulatory pathway for medical devices, where approval is based on a determination by the FDA that the PMA contains sufficient valid scientific evidence to ensure that the device is safe and effective for its intended use, and that the benefits of the procedure and device outweigh its risks. The FDA’s Summary of Safety and Effectiveness Data, states “Based on the clinical study results, it is reasonable to conclude that a significant portion of the indicated patient population will achieve clinically significant results. In conclusion, the coflex® device represents a reasonable alternative to posterolateral fusion for the treatment of spinal stenosis.”

Marc Viscogliosi, Chairman and CEO, stated “This study provides the evidence insurance companies, surgeons and patients have been demanding. Insurance companies, surgeons and patients finally have an alternative to fusion which, based on independent study data, has demonstrated that coflex® produces better outcomes, a faster recovery, preserves motion and may be performed on an outpatient basis. For patients, the ability to walk without back pain and the progressive symptoms of stenosis is one of the most cherished functions of the aging population.”

Hal Mathews, M.D., Executive Vice President and Chief Medical Officer, stated “The coflex® study results represent a celebration of evidence for surgeons, their patients and the insurance community. We now have objective evidence of the detrimental clinical effects and relatively expensive costs of pedicle screw fusion on spinal stenosis patients. Although outcomes for pedicle screw-based fusions have been historically acceptable, it was the only option surgeons had for the last 25 years to provide stabilization when indicated, along with the decompression procedure. Importantly, coflex® was able to deliver better outcomes at a significantly lower cost to the healthcare system, which we believe is an important mandate of the current healthcare reform law.”

Reginald Davis, M.D.3, Principal Investigator for the coflex® study, stated “This is the first time a new spinal technology is proven to be better and more effective than the historical gold standard, and is still actually lower cost. I am excited to be able to provide coflex® to my patients without the need for fusion through a simple, motion preserving, and minimally invasive bone-saving surgical technique.”
For additional information on Paradigm Spine LLC, the coflex® interlaminar technology and the coflex® procedure, please visit our new website at www.paradigmspine.com.

About Paradigm Spine LLC
Paradigm Spine LLC, founded by Viscogliosi Bros., LLC in 2004, is a privately held company focused on the design, development and marketing of solutions for the treatment of spinal conditions and diseases. The company's signature product is the coflex® Interlaminar Stabilization™ device, which has more than 18 years of clinical history with regulatory approval in more than 40 countries throughout 6 continents.
About Lumbar Spinal Stenosis

According to the American Association of Neurological Surgeons (AANS), lumbar spinal stenosis is defined as the narrowing of the spinal canal that compresses the nerves traveling through the lower back and into the legs. While it may affect younger patients due to developmental causes, spinal stenosis is a condition most commonly caused by degenerative changes of the spine in people age 60 and older. Its symptoms include pain, weakness, or numbness in the legs, calves or buttocks and are often associated with low back pain. More than 400,000 Americans, most over the age of 60, may be suffering from the symptoms of lumbar spinal stenosis, and as many as 1.2 million Americans have back and leg pain related to any type of spinal stenosis.

As stated by Katz et al. in the New England Journal of Medicine (February 2008), lumbar spinal stenosis is the most frequent indication for spinal surgery in patients older than 65 years of age.

Forward-Looking Statements
This news release contains forward-looking statements as defined in the U.S. Private Securities Litigation Reform Act of 1995. Readers are cautioned not to place undue reliance on these forward-looking statements. Actual results may differ materially from those indicated by these forward-looking statements as a result of risks and uncertainties impacting Paradigm Spine LLC’s business including increased competition; the ability of Paradigm Spine LLC to expand its operations and to attract and retain qualified professionals; technological obsolescence; general economic conditions; and other risks.

1 These results were obtained from analyses of intraoperative, postoperative, perioperative, narcotics and supply costs, and were derived from actual costs reported by study sites, supplemented by estimates or assumptions where actual numbers were not or could not be obtained.
2 Carreyrou, J, & McGinty, T. Top Spine Surgeons Reap Royalties, Medicare Bounty. Wall Street Journal. Retrieved October 12, 2012 from http://online.wsj.com/article/SB10001424052748703395204576024023361023138.html.
3 Dr. Davis provides training and education services for Paradigm Spine LLC. Dr. Davis does not receive any royalty income from, and is not an investor in, Paradigm Spine LLC.

Thursday, September 6, 2012

The Promise of Regenerative Medicine

Kenneth A. Pettine, MD
Co-founder of The Spine Institute and founder of the Orthopedic Stem Cell Institute

Dr. Kenneth Pettine of the Orthopedic Stem Cell Institute provides a preliminary but promising report on allogeneic mesenchymal precursor cells.


Administering undifferentiated stem cells to an injured disc has made adult stem cell regenerative medicine in spine a reality. Adult stem cell regenerative medicine holds the promise of stabilizing or even reversing the degenerative changes associated with aging or following traumatic injury. Current clinical use of stem cells is very limited, in part by the cumbersome approval process. The use of concentrated bone marrow aspirate (BMC) as a “stem cell” preparation is currently the simplest and safest way of utilizing the regenerative potential for mesenchymal stem cells (MSCs) to promote tissue regeneration. In fact, stem cells concentrated from bone marrow have been shown to stimulate the formation of bone, cartilage, ligament and tendon, and dermal tissues.

Conservative treatment options for lumbar and cervical pain associated with discogenic disc disease (Pfirrmann Grades 3-6) are limited. Treatment options include pain medication, steroids, physical therapy, and chiropractic care. Reversal of disc pathology has not been achieved with current available treatment modalities. Failure of these nonoperative treatments may leave surgical intervention as a treatment option.

The goal of utilizing MSCs is to not only potentially provide pain relief from the painful degenerative disc, but to reverse the degenerative process. There are three methods for placing MSCs into the painful nucleus pulposus.

The use of allogeneic mesenchymal precursor cells (MPCs) is currently being evaluated as a part of an FDA Phase I clinical trial. Extracted from donors and expanded in number by tissue culture, this process isolates and grows the stem cells into pure MPCs which are injected into the nucleus pulposus. This technology does not have FDA approval.

Utilizing expanded, autologous MSCs for injection into the painful disc is the second method. Federal regulations require the approval of an Investigational New Drug application supported by prospective, randomized clinical trials for the use of expanded autologous MSCs. The FDA has not approved this technology.

The third method involves autologous point of care therapy. This technology does not require FDA approval. The patient’s own MSCs are directly injected into the nucleus pulposus of the symptomatic degenerated disc(s) using standardized two needle discography technique. This requires fluoroscopic visualization and 2-3cc of MSCs are slowly injected into the symptomatic nucleus pulposus.

I have used Celling Biosciences ART21 technology to perform autologous point of care therapy since October 2011. To date, I've performed 72 autologous MSCs injections in the lumbar and cervical spine.

Research conducted at the Spine Institute includes an IRB approved, prospective, two-arm study to evaluate the treatment of discogenic low back pain with intradiscal injection of autologous bone marrow-derived cells.

Early analysis of the research data reveals the average lumbar pre-treatment Oswestry Disability Index (ODI) was 56.5% and improved to 22.4% at three-month follow-up (P=0.0001). The average lumbar pre-treatment Visual Analogue Scale (VAS) for pain was 7.9 (on a scale of 1-10) and improved to 4.2 at three months (P=0.0005).

There have been no complications associated with the iliac crest aspiration or disc injection. Thus far no patient in the study has undergone spine surgery following treatment. Results obtained with this technique suggest its potential clinical efficacy in the treatment of moderate to severe degenerative disc disease. These results require verification with longer follow-up and randomized prospective studies.

For more information regarding treatment options please visit our websites at SpineRevolution.com or OrthopedicStemCellInstitute.com.

See this article online on the International Society for the Advancement of Spine Surgery website.

Friday, August 24, 2012

Spine Surgeon Dr. Kenneth Pettine to Co-Host Meeting on Ambulatory Spine Surgery

Leading spine surgeons, ambulatory surgery center experts
to gather in Dallas in October


LOVELAND, Colo. – August 23, 2012 — Kenneth Pettine, MD, founder of The Spine Institute and Loveland Surgery Center in Colorado, is pleased to announce an upcoming meeting and cocktail reception supporting spine surgery in an ambulatory surgery center.

The meeting will take place October 25, 2012, from 5:30-7:30 p.m. in the West End Room at the Omni Hotel in Dallas, Texas. It is hosted by Dr. Pettine and Paradigm Spine. Two panels of nationally recognized spine surgeons and ASC financial experts will discuss a number of topics, including the benefits of spine surgery performed at an ASC, how to build and operate a successful ASC, education on insurance approval for spine surgeries at an ASC, current research and advanced technology.

The panelists scheduled to speak are as follows: Dr. Kenneth Pettine; Dr. Donald Johnson II, founder of Southeastern Spine Institute in South Carolina; Dr. John Peloza, founder of Center for Spine Care in Dallas; Dr. Alan Villavicencio, founder of Minimally Invasive Spine Institute in Colorado; Kenneth Hancock, president of Meridian Surgical Partners; Jeff Leland, CEO of Blue Chip Surgical Center Partners; Marc Viscogliosi, CEO of Paradigm Spine; and Robin Young, founder of Pearl Diver.

"I am very pleased to host this symposium. It will bring together some of the most prolific spine surgeons and ASC experts to discuss quality and financial topics on outpatient spine surgery," said Dr. Pettine. "Attendees will come away with a greater understanding of the clinical and economic benefits for patients, payers and surgeons when spine surgery is performed at an ASC."

The symposium's main sponsor is Access MediQuip, with additional support provided by
Meridian Surgical Partners and Blue Chip Surgical Center Partners.

To learn more about the meeting and RSVP, contact Kay Roberts at (970) 286-1329 or
kroberts@spinerevolution.com.

Note: This symposium is not part of the official program as planned by the NASS Annual Meeting Program Committee.

About Dr. Kenneth Pettine
Kenneth Pettine, MD, is founder of The Spine Institute and Loveland Surgery Center in
Colorado, and co-founder of the Society for Ambulatory Spine Surgery. He has an extensive background in spinal surgery, research and rehabilitation; is co-inventor and co-designer of the Maverick artificial disc, a disc replacement device for the low back; and is co-inventor of the Prestige cervical artificial disc. He is the principal investigator for a dozen FDA studies involving non-fusion spine technology. www.spinerevolution.com

Wednesday, July 11, 2012

Mesoblast Interview: The Best Adult Stem Cell Technology in the World?


As published on www.propthink.com Read article online here.
Mesoblast (MSB.AX) (OTC:MEOBF) CEO Silviu Itesu speaks on his company`s adult stem cell technology, particularly mesenchymal precursor cells, and the low-cost manufacturing capabilities that the technology implies. Itesu discusses development compound Revascor for use in congestive heart failure and details the latest Phase II results. In 60 patients the drug saw no adverse events and a 0% event rate (hospital visits, mortality) compared to 20% in a control group; the company is planning to initiate a 1500-patient Phase III study in the coming few months. The trials are funded entirely by Teva (TEVA), says Itesu, but the company`s financial situation would allow for a few years of `solo` operation.
Itesu briefly compares Mesoblast`s production strategies to those of Dendreon`s (DNDN) Provenge, and explains how Mesoblast`s production will be significantly less expensive. The conversation also covers two more pipeline products, a Type-2 diabetes treatment and an intervertebral disc treatment, both of which have shown promising results in Phase II studies. 
Click here to view the video interview of Mesoblast CEO Silviu Itesu.

Thursday, June 21, 2012

Eight ASCs in the United States Embracing Medical Tourism

Written by Laura Miller | Becker's ASC Review | June 21, 2012

Here are eight ambulatory surgery centers that have embraced medical tourism in the United States and attract patients from other countries. 

Red Rock Surgery Center (Las Vegas). Red Rock Surgery Center reaches out to its Las Vegas community as well as patients from around the world with their medical tourism branch. The surgery center was founded more than 10 years ago and surgeons perform approximately 1,000 procedures there annually. The center includes three operating rooms and one minor laser procedure room, allowing surgeons to perform a multitude of cases at the ASC. Medical staff at the center includes ophthalmologists, plastic surgeons, pain management physicians, hand surgeons, general surgeons and podiatrists. Red Rock Surgery Center is accredited by the Accreditation Association for Ambulatory Health Care and owned by David Malitz, MD.

The Surgery Center at Doral (Doral, Fla.). The Surgery Center at Doral includes interventional pain management, urology, general surgery and hand and upper extremity surgery. Alejandro Badia, MD, founded Badia Hand to Shoulder Center which works with the International Orthopedic Group to serve inbound medical tourist patients, who have their surgeries at The Surgery Center at Doral. The surgery center has three operating rooms, arthroscopic equipment and family waiting room. After traveling for their surgery, patients are able to stay at a hotel located near the center for recovery, often accompanied by a recovery room nursing staff. The patients are able to have rehabilitation and follow up visits while staying for a few days in the area.

Legacy Neurosurgery Spine & Brain Specialists Outpatient Surgery Center (Little Rock, Ark.).
 Legacy Neurosurgery Spine & Brain Specialists has served patients who travel across the country to have their surgery performed at a lower cost than it would be at their local hospital. They often serve cash-pay or high deductible patients traveling long distances. Led by Scott Schlesinger, MD, the team of neurosurgeons performs minimally invasive spine surgery as well as non-operative pain management procedures. The brain disorders they treat include brain tumors, aneurysms and arterial venous malformations. Additional services at the center include physical therapy.

Orthopedic Surgery Center of Orange County (Newport Beach, Calif.).
 The Orthopedic Surgery Center of Orange County is owned by the Orthopedic Specialists of Southern California and Hoag Hospital. It is a medical tourism facility associated with Patients Without Borders and has been an accredited ambulatory surgery center since 1999. Surgeons perform several procedures at the center, including ACL reconstruction, meniscus repair, shoulder surgery and spine surgery. The center is contracted with major insurance companies and will bill non-contracted payors. 

Surgery Center of Oklahoma (Oklahoma City).
 Surgery Center of Oklahoma is a 32,535-square-foot facility that is owned and operated by surgeons and anesthesiologists in central Oklahoma. The facility has been accredited by the Accreditation Association for Ambulatory Health Care since 1998 and includes prices for their services on the ASC website to attract patients of self-pay, self-insured or high-deductible plans. Surgeons at the ASC perform orthopedics, general surgery, ophthalmology, and ENT procedures. There are multiple lodging areas near the surgery center for patients to stay after their procedures. According to the ASC's website, they are able to offer lower prices since they don't have to process claims and there is no risk of non-payment.

Concord (N.H.) Ambulatory Surgery Center.
 Concord Ambulatory Surgery Center is accredited by the Accreditation Association for Ambulatory Health Care and provides ENT, orthopedics, plastic surgery, general surgery and pain management procedures. The facility has two operating rooms, four bed preparation areas and eight station recovery areas. Concord Ambulatory Surgery Center provides complete coordinated care to Canadian patients, which includes scheduling appointments, travel, accommodation and transportation to the facility. The procedures offered to medical tourism patients include knee arthroscopy, ACL reconstruction, liposuction, tonsillectomy and rotator cuff repair.

Loveland (Colo.) Surgery Center. 
Kenneth Pettine, MD, spine surgeon and co-owner of Loveland Surgery Center, noticed that patients were traveling to India and Germany to pay cash for procedures such as lumbar artificial disc replacement, which some insurance companies do not cover, although the technology is cleared by the FDA and surgeons in the United States can perform them. He felt he could provide these patients the same quality procedure at Loveland Surgery Center at a lower price if the patients were willing to pay cash. The cash price includes implant, surgeon, facility and anesthesia fees. Loveland Surgery Center is a Joint Commission-accredited facility.

Squaw Peak Surgery Center (Phoenix). 
Squaw Peak Surgery Center was founded in 1998 by Anthony Yeung, MD, and has two operating rooms. The surgeons perform endoscopic spine surgery and a dorsal endoscopic rhizotomy surgery invented and developed by Dr. Yeung. The surgery center can accommodate cash pay patients and Dr. Anthony's practice, Desert Institute for Spine Care, offers to coordinate care for medical tourists. The surgery center also has negotiated discounted rates at area hotels for their patients. The surgeons are team spine surgeons for several professional athletes, including the Arizona Diamondbacks, Colorado Rockies, Kansas City Royals, Seattle Mariners, Los Angeles Dodgers and Cincinnati Reds.


Read this article online

Wednesday, June 20, 2012

Key Challenges, Opportunities for Growth in Spine Surgery

Written by Bob Spoerl | Becker's ASC Review | June 18, 2012

At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 15, Kenneth Pettine, MD, a spine surgeon at the Loveland (Colo.) Surgery Center; Larry Teuber, MD, a spine surgeon and president of Medical Facilities in Rapid City, S.D.; and Timothy T. Davis, MD, DABNM, DABPMR, DABPM, a spine surgeon and director of interventional pain and electrodiagnostics at The Spine Institute in Los Angeles, discussed trends in spine surgery and ideas for improving profitability and outcomes of spine programs. Scott Becker, JD, CPA, partner at McGuireWoods, moderated the session. 

Mr. Becker kicked off the discussion by asking the spine surgeons some of the top spine surgery trends on their minds.

Dr. Davis said he sees a growing trend of spine centers and surgeons needing to meet certain criteria to get surgeries covered. He compared the trend to what he said has happened to cardiology.

"I think it's going to come down to really having to follow a strict algorithm of spine care, he said. "We already have to do this in the worker's compensation environment."

Electronic medical records will become increasingly important for spine surgeons to ensure every procedure has been tried and standards are being followed,  which is critical for reimbursement.

Dr. Pettine said he's seeing a trend in payors denying spine procedures, what he called a "dramatic change" in spine surgeons' ability to get surgeries authorized. He suggested all orthopedic surgeons study insurance plans' guideline packets, which state the requirements needed to get procedures authorized.

"If you don't understand the rules, you can't play the game," he said. 

He predicted the total number of spine procedures performed could drop by as much as 30 percent in the next year because of payor denials. 

Dr. Teuber echoed the notion by saying the backlog of pre-authorizations for spine surgeries is huge.

Later in the conversation, Mr. Becker asked the panel about some of the most exciting developments they're seeing.

"Biologics are far and away the next frontier of spine," Dr. Davis said. He was referring to the use of biologics both in surgery and prior to it. He said it's the "biggest single improvement in spine care."

Dr. Teuber agreed and added "implants will always be a growth area too.”

Dr. Pettine discussed the future in terms of where spine procedures happen. "Spine care in an ASC setting is absolutely the future," he said. It's the place where "all of the modern minimally invasive techniques for spine" can be utilized.

"The hospitals absolutely cannot compete with an ASC," he added. "We can provide this care [for] significantly less."

In order to be profitable over the next five years performing spine surgery, Dr. Pettine said spine centers should seriously look at case rates. There's an opportunity for ASCs to pick up potential spillover patients from other surgeons who sign with hospitals but lack the time to perform as many surgeries, he said.

"As far as hospitals purchasing doctors, I think that's great. The minute the hospital purchases several neurosurgeons, then he's no longer competition," he said.

Dr. Kenneth Pettine: Four Points on Performing Spine Surgery in ASCs

Written by Laura Miller | Becker's ASC Review | June 18, 2012

At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 15, Founder of The Spine Institute and Loveland (Colo.) Surgery Center Kenneth A. Pettine, MD, gave a presentation titled "Everything You Need to Know to Successfully Perform Spine Surgery in an ASC." In his presentation, Dr. Pettine touched on several factors that will make it easier to bring spine procedures into an ambulatory surgery center in the future. 

"My goal is to move 50 percent of inpatient hospital spine surgeries in the United States to an ASC," Dr. Pettine said. "I would encourage everyone to be involved in the Society for Ambulatory Spine Surgery. We need to change current Medicare ASC guidelines, which will allow us to perform more cases in the ASC. We've seen this trend with arthroscopies."

1. Negotiate down implant costs. 
It's important to negotiate down implant prices to retail prices, if they aren't already there. "It's not difficult to negotiate 40 to 60 percent discounts on implants," said Dr. Pettine. "Share that discount with spine surgeons."

Also consider implant cost when negotiating for payor contracts. "Don't leave implant money on the table," said Dr. Pettine. "Have appropriate contracts to perform spine surgery at the ASC."

2. Give surgeons the numbers.
 If surgeons in your community are dragging their feet about bringing cases into the surgery center, give them data to show them the impact it could make on their practice. "Surgeons are rather reticent to change their practice patterns," said Dr. Pettine. "They do the same procedures they did 10 to 20 years ago. One of the ways you can convince them to change is with data. With numbers is power."

The most important data to highlight includes:

•    Turnover times, which should be around 10 minutes in the ASC compared to 45 minutes in the hospital
•    Implant income with percentage over cost
•    Infection control data

3. Build a convalescence center.
 A convalescence center allows patients who need extra recovery time to stay 23-plus hours in the facility after outpatient spine surgery. If constructing a convalescence center isn't possible, consider partnering with other facilities for discharging patients who aren't quite ready to return home.

"You can accomplish the same thing as a convalescence center with a rehabilitation facility or nursing home," said Dr. Pettine. "There are ways to accomplish this same type of facility in states where surgery centers can't get a convalescence license." 

4. Procedures performed in a surgery center
. Right now, typical procedures performed in the surgery center include anterior lumbar interbody fusions, posterior lumbar fusions, artificial disc replacements and sacroiliac joint fusions. "Currently, these are not controversial procedures to perform in an ASC because we have gathered effectiveness data," said Dr. Pettine. "We've done about 1,700 non-instrumented cases in the ASC and because of published data they aren't controversial."

Dr. Pettine also participates in clinical trials using biologics during spine surgery. "There are approximately 20 different types of adult stem cells in your body," said Dr. Pettine. "In orthopedics, we use mesenchymal stem cells. The goal is to harness the natural healing potential of stem cells. I am unaware of any adverse effects of using the patient's own stem cells."

After harvesting the stem cells, they are processed and then implanted back in the patient to promote fusion. The FDA considers the procedure the same as blood transfusion. "Results of the study are extremely promising," said Dr. Pettine. "The more you learn about this technology, the more optimistic you become."


Read this story online

Five Trends in Orthopedic and Spine Devices and Implants

Written by Taryn Tawoda | Becker's ASC Review | June 18, 2012

In a session titled "New Developments in Orthopedic and Spine Devices and Implants" at the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago, Chris Zorn, vice president of sales at Spine Surgical Innovation, and Kenneth A. Pettine, MD, founder of the Spine Institute and Loveland Surgery Center, discussed trends and developments in orthopedic and spine implants. 

1. The focus is on developments that inspire innovation. Mr. Zorn said he has seen devices developed with an emphasis on making the healthcare system more efficient and less costly, particularly since reimbursement is under tremendous pressure. "What can we do to help make the procedures less traumatic for patients, easier for the surgeons and less expensive for the healthcare systems paying for all of this?" he said. "Delivering surgery in an ASC is obviously different from surgery in a hospital. You have to keep an eye on what you're doing and look for incremental changes that can help you or your patient in the OR, and changes that you can get paid for."

2. Innovative spine implants in the U.S. are hindered by a complicated regulatory process. A lengthy FDA approval process can delay many innovative implants in the U.S., said Dr. Pettine. "I am extremely optimistic about the future of spine surgery in ambulatory surgery centers, but I'm very pessimistic about the future of really innovative spine implants in the U.S.," he said, adding that the U.S. is behind in implant developments compared to other parts of the world. "Europe is at least three to five years ahead of us in terms of spinal implant technology. In the U.S., a study will take at least one year, then there is a two year wait for data, and then the FDA may sit on data for five years."

3. Venture capital money is declining. According to Dr. Pettine, venture capital money for new devices is draining, and the lengthy FDA device approval process is largely to blame. "When people invest in something, they're expecting a minimum five-year turnaround with that money," he said. "But in the U.S., we’re looking at seven to 10 years before a device gets approval, so this venture capital money is going elsewhere."

4. Reimbursements for disposables are low. Disposable supplies are not reimbursed well, said Dr. Pettine. "You can get reimbursed for an implant, but not disposables, in an ASC setting," he said. "So if a technique is associated with a lot of disposables, may not work for you at your surgery center."

5. Using more disposables can save money long-term. "Some countries want you to do everything disposable," said Mr. Zorn. "Since the pressure is on everybody to deliver more for less, switching your capital investment into a disposable method makes a lot of sense. The problem is that disposables are still outrageously priced in the U.S."


Read article online.

Wednesday, June 6, 2012

10 ASC Industry Leaders to Know

From Becker's ASC Review

Written by Rachel Fields | June 02, 2012


Here are 10 profiles of notable leaders in the ambulatory surgery center industry. 

1. Dr. Stephen Hochschuler of the Texas Back Institute. Stephen Hochschuler, MD, is co-founder of the Texas Back Institute in Plano, which began in 1977 in partnership with Ralph Rashbaum, MD. Their joint vision for the institute was to create "an integrated multispecialty spinal clinic that included prevention, conservative care, surgical care, rehabilitation and research and development." Thirty-five years later, the center is heralded as one of the premier organizations for spine healthcare, becoming the first institution in the United States to prescribe outpatient myelography and the first to lead an FDA study of the artificial disc and artificial disc replacement.

2. Barry Tanner, CEO of Physicians Endoscopy. Mr. Tanner joined Physicians Endoscopy in 1999 and co-authored the company's business plan with CFO Karen Sablyak. He currently oversees the company's partnership development activities, as well as strategic direction and services management. He also helps in the day-to-day management and governance of some of Physician Endoscopy's partnered facilities. Before joining PE, Mr. Tanner served as CFO of Navis Radiology Systems, a physician practice management company in Miami. As the co-founder and CFO, he was responsible for developing a business plan. He helped grow the company from zero to over $75 million in revenues during his time as CFO, including the acquisition of seven professional radiology practices and a major diagnostics company.

3. Dr. Kenneth Pettine of Loveland Surgery Center. Kenneth Pettine, MD, is a spine surgeon and the founder of the Spine Institute and Loveland (Colo.) Surgery Center and Rocky Mountain Associates in Orthopedic Medicine. Dr. Pettine is board certified and a member of the American Academy of Orthopedic Surgeons, the North American Spine Society and the Arthroscopy Association of North America. He received his fellowship training at the Institute for Low Back Care in Minneapolis, completed his residency and his master's degree in orthopedic surgery at the Mayo Clinic in Rochester, Minn., and was awarded his MD from the University of Colorado School of Medicine.

4. Michel Kulcyzcki of The Joint Commission. As executive director for The Joint Commission's Ambulatory Care Accreditation Program, Mr. Kulczycki is responsible for overseeing the strategy and business development for the Ambulatory Care Accreditation Program. Prior to joining The Joint Commission in 2002, Mr. Kulczycki served as principal officer at Oak Park, Ill.-based M.Carl Enterprises, a provider of management consultant services to non-profit organizations. He also served as president and CEO of The Alliance for Healthcare Strategy and Marketing in Chicago for two years and as executive director of the Illinois Home Care Council, also in Chicago, for seven years.

5. Brent Ashby, administrator of Audubon Surgery Center. Brent Ashby is the administrator of two surgery centers — Audubon Surgery Center and Audubon ASC at St. Francis, both located in Colorado Springs, Colo. The two Audubon centers contain 15 operating rooms and four procedure rooms between them and perform an estimated 19,000 cases annually. Mr. Ashby has led the surgery centers through several successful initiatives, including a staff profit-sharing program and a boycott of payors who are unwilling to offer reasonable payment rates. He said the physicians in his centers are highly involved and offer their support during difficult administrative decisions.

6. Dr. John Cherf of Vanguard Chicago Center for Orthopedics. John Cherf, MD, an orthopedic surgeon, is the president of the Chicago Institute of Orthopedics, president of OrthoIndex and clinical advisor to Sg2, a healthcare intelligence and information services company. Dr. Cherf, who has more than 20 years of clinical experience in orthopedics and sports medicine, completed his medical education at Northwestern University in Chicago, where he also obtained a Masters in Public Health and Masters in Business Administration. He also completed his internship and residency at Northwestern and then completed a fellowship in sports medicine and knee surgery at The Orthopedic Specialty Hospital/Sports Medicine West in Salt Lake City. 

7. Dr. Joseph Banno, founder of Peroria Day Surgery Center. Joseph Banno, MD, founder of the successful Peoria (Ill.) Day Surgery Center and past ASC chairman, is committed to providing quality healthcare all over the world. He helped pioneer the development of the world's first mobile ASC, a self-contained surgery unit that allows physicians to provide medical and surgical treatment in remote areas of the world. The unit can provide "rural outreach, hospital renovation replacement facility, international health care delivery, mobile intensive care, mobile dialysis" and a variety of other services, Dr. Banno said in an interview with Peoria Magazine.

8. Luke Lambert, CEO of ASCOA. Luke Lambert became CFO of Ambulatory Surgery Centers of America in 1997 and was promoted to CEO of the company five years later. He previously held positions at Smith Barney, Booz, Allen & Hamilton and Ernst & Young. His background includes experience in finance, strategy and operations and he has worked in venture exploration and reengineering business processes. Mr. Lambert was one of the founding members of ASCOA, an ASC management and development company that has started or turned around more than 60 projects in the United States. Within ASCOA’s management model, surgeons maintain the majority ownership of the center while the company holds a minority share in each center it turns around or develops.

9. Joe Zasa, co-founder of ASD Management. As the co-founder and managing partner of ASD Management, Joe Zasa focuses on turning around existing surgery centers and helping physicians and hospitals develop new ASCs. An expert in surgery center profitability, Mr. Zasa is keenly aware of some of the ways ASCs fail: by failing to look at case costs, letting supply expenses run out of control and depending on poor payor contracts. Prior to founding ASD Management, formerly Woodrum ASD, Mr. Zasa served as corporate counsel for Premier Ambulatory Systems, where he was responsible for acquisitions and physician development. He also served as regional director of surgery operations for ProSurg, a division of American Ophthalmic.

10. Alfred McNair, MD, founder of Digestive Health Center. Alfred McNair, MD, a gastroenterologist, founded the Digestive Health Center in 1980 on the Mississippi Gulf Coast, where he has been practicing ever since. He sees patients at four different offices in the area and performs colonoscopies, esophagogastrodeudenoscopies and Enterynx. He also has a special focus on liver disease and hepatitis illness. Dr. McNair earned his medical degree at Columbia University College of Physicians and Surgeons in New York City and completed his residency at New York Presbyterian Hospital. His additional training includes a fellowship at Stanford University in Palo Alto, Calif.

Thursday, April 19, 2012

Spine Leader to Know: Dr. Kenneth Pettine of The Spine Institute

Written by  Bob Spoerl | April 17, 2012 | Becker's Spine Review


Kenneth Pettine, MD, is co-founder of Rocky Mountain Associates in Orthopedic Medicine and The Spine Institute in Loveland, Colo. In addition, he co-invented and co-designed the Maverick Artificial Disk as well as the Prestige Cervical Artificial Disc.
Throughout his career, Dr. Pettine has focused on innovation and was among the first spine surgeons to perform a minimally invasive lumbar disc procedure using the Mesoblast Limited technology. The procedure was performed in a Phase 2 clinical trial of the adult Mesenchymal Precursor Cell product for treating patients with low back pain and degenerative disc disease.

He performs outpatient spine surgery in a surgery center and has predicted that over the next several years, 50 percent of spine procedures could move into the outpatient setting. He also provides cash pay for spine surgery at his center.

"We were noticing many patients were considering going to Germany or India where they could pay cash for an ADR," Dr. Pettine says. "We felt we could offer these patients a cash price similar to what they would pay overseas but allow them to have their surgery close to home by a surgeon they know and trust. Follow up is easier and more efficacious."

Dr. Pettine's background is in spinal surgery, research and rehabilitation. His spine fellowship was at the Institute for Low Back Care in Minneapolis, and he complete residency and a master's degree in orthopedic surgery at the Mayo Clinic in Rochester, Minn. He earned a medical degree from the University of Colorado School of Medicine.

Dr. Pettine holds 14 awards from medical school and residency, has been published 22 times and presented at 45 events and conferences around the world. He recently founded the Society for Ambulatory Spine Surgery, which he launched last November with Access MediQuip. He is a member of the American Academy of Orthopaedic Surgeons, North American Spine Society and Arthroscopy Association of North America.

Friday, March 30, 2012

ASC Industry Leader to Know: Dr. Kenneth Pettine of Loveland Surgery Center

Written by Taryn Tawoda | March 29, 2012 | Becker's ASC Review

Kenneth Pettine, MD, is a spine surgeon and the founder of the Spine Institute and Loveland (Colo.) Surgery Center and Rocky Mountain Associates in Orthopedic Medicine.

When considering surgery center trends for 2012, Dr. Pettine told Becker’s ASC Review, "I think there's going to be a very renewed interest in ASCs. It is profitable to do spine surgery at an ASC for both the spine surgeon and other owners, and implant costs can be a source of additional passive income. Include 12-minute turnaround times and overall efficiency, patient satisfaction and this situation is too good for a spine surgeon not to desire. I have no intention of changing my ownership structure. In fact, I just want to own more."

Dr. Pettine is board certified and a member of the American Academy of Orthopedic Surgeons, the North American Spine Society and the Arthroscopy Association of North America. He received his fellowship training at the Institute for Low Back Care in Minneapolis, completed his residency and his master's degree in orthopedic surgery at the Mayo Clinic in Rochester, Minn., and was awarded his MD from the University of Colorado School of Medicine.

Dr. Pettine previously served as a staff orthopedic surgeon and chief of the sports medicine clinic at Eisenhower Army Medical Center in Fort Gordon, Ga.; associate clinical professor at the Medical College of Georgia; and visiting consultant at the Veteran's Administration Hospital in Augusta, Ga.

Wednesday, March 28, 2012

Positive Signs for Gene Therapy in Slowing the Course of Disc Degeneration

Spinal News International - Issue 22, March 2012 -- view as PDF

A new study, which was presented at the annual meeting of the North American Spine Society (NASS; 2–5 November 2011, Chicago, USA) and subsequently published online in The Spine Journal, has found that gene therapy has the potential to delay disc degeneration.

Lead author Steven Leckie, Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA, and co-investigators reviewed the use of the adeno-associated virus sero-type 2 (AAV2) vector carrying genes for either bone morphogenetic protein 2 (BMP2) or tissue inhibitor of metalloproteinase 1 (TIMP1) to manage degenerative disc disease in New Zealand white rabbits. Explaining the purpose of the study, Leckie, who presented the data at NASS, said: “BMP2 is known to induce proteoglycan production in the intervertebral disc and TIMP1 is anti-anabolic in that it prevents the breakdown of proteoglycan. The problem with growth factors is that they are transient, so the philosophy of gene therapy is that we might be able to induce a sustained response from the host.” He added that, in their study, which won the 2011 outstanding Paper: Basic Science award at NASS, they used AAV2 because it has been shown to be safer than other vectors used in previous studies.

The 34 skeletally mature rabbits used in the study were divided into five groups: non-surgical (negative controls; six), sham procedure (negative controls; four), puncture surgery (underwent puncture surgery but did not receive any subsequent therapy, positive controls; eight), puncture surgery followed by treatment with AAV2-BMP2 (eight), and puncture surgery followed by treatment with AAV2- TIMP1 (eight). Puncture surgery was performed with a 16-gauge needle, which has been reliably shown to induce degeneration, in L2-L3, L3-L4, and L4-L5 discs. Leckie said: “The outcomes that we measured included MRI, histology, biomechanics, and biochemistry.”

After 12 weeks, rabbits in the non-surgical and the sham procedure groups did not show any evidence of disc degeneration on MRI but all rabbits in the puncture surgery group did have evidence of disc degeneration (on MRI, images of nucleus pulpous in the affected area darkened and decreased over the 12 weeks of the study). About the treatment groups, Leckie said: “Although they did have some degree of
disc degeneration, they appeared to have less degeneration than the puncture group.” In The Spine Journal paper, Leckie et al reported that the nucleus pulpous of the treated groups “retained their size and did not darken as much as the punctured discs.”

Leckie said that he and his fellow investigators also collected serum biomarkers for C-telopeptide II, which he explained is the breakdown product of C-terminus of collagen II and could be measured in the serum. He added: “At 12 weeks, the control rabbits had a slight increase [the rabbits in the non-surgical group], the
puncture rabbits had significantly higher serum values, and the treatment groups had values that fell well below those of the puncture group.”

As well as the MRI data and the biomarker data, there was also histological data. Leckie said: “The discs of the control and sham rabbits appeared to be normal. The punctured discs appeared relatively acellular and more fibrotic, and the discs that were treated with AAV2-BMP2 or AAV2-TIMP1 gene therapy had a relative maintenance of cellularity and relative preservation of their architecture.”

Leckie concluded by saying: “We have MRI evidence, serum biomarker evidence, biomechanics evidence, and histology evidence that gene therapy treatment with AAV2-BMP2 or AAV2-TIMP1 might help slow the course of disc degeneration in a rabbit model.”




For Back, Neck Pain, Artificial Disc Replacement Has Cost, Outcome Advantages Over Fusion Surgery

ScienceDaily (Mar. 22, 2011) —

When physical therapy and drugs fail to relieve back or neck pain, patients often turn to spinal fusion surgery as a last resort, but two new studies show that in certain situations, especially when several discs are involved, artificial disc replacement may give better long-term results at lower cost.

Hospital costs for artificial disc replacement were 49 percent lower, and four years out from surgery, artificial disc patients were four times less likely to need additional surgery than those who had fusion operations, according to two recently published studies.

"Back pain is the fifth leading cause of hospital admission and the third most common reason for surgery," said orthopaedic surgeon Rick B. Delamarter, M.D., co-director of the Cedars-Sinai Spine Center. "Estimates vary and are probably understated, but health care expenditures for back pain top $91 billion a year, not including indirect and societal costs such as time lost from work and worker's compensation.It is crucial that we develop surgical procedures that are cost effective without sacrificing high-quality results."

Delamarter is a lead author of the two studies, which were published recently in the SAS Journal of the International Society for the Advancement of Spine Surgery and the Society for Minimally Invasive Spine Surgery.

Both studies compared disc replacement surgery with the more common fusion operation to treat degenerative disc disease -- deterioration caused by aging and wear and tear. One study looked at 209 patients with damaged neck discs who received either minimally invasive disc replacement or the more complex spinal fusion surgery. These patients were followed at regular intervals for four years. A separate group of 136 who received an artificial disc two years after the first group also were part of the study. All patients were assessed on their satisfaction with the results of the procedure. The other study focused on 53 patients suffering from three-level, lower back disc disease and looked at cost comparisons for length of hospital stay, resources used and other factors

Discs act as cushions between the bones (vertebrae) of the spine. When healthy, the discs have enough "give" to allow the back to be flexible but are firm enough to provide stability. With age or injury, they lose their pliability and density. Nerves may become pinched between the bones, causing pain not just in the spine but in other parts of the body.

Fusion surgery seeks to relieve symptoms of the degenerative disease by removing the damaged disc and replacing it with bone. Studies show this procedure often can be effective but there can be drawbacks: in some cases, fused spinal sections can lose flexibility, impeding normal movement and stressing adjacent discs, often leading later to more fusion surgery. Artificial disc replacement, which has been performed in the United States since 2000, tends to cause less tissue injury than fusion surgery, and the discs are designed to maintain natural spine movement and reduce need for follow-up surgery.

In their study of patients suffering neck (cervical) disc disease, Delamarter and his colleagues found both disc replacement and fusion surgery acceptable options providing good long-term outcomes. But four years out from surgery, fusion patients were four times more likely to need more surgery. Half of these secondary operations were needed to treat new disc problems occurring adjacent to fused sections.

Patients in the study had imaging scans to measure before-and-after flexibility and range of motion; were evaluated for physical and neurological improvement; and completed self-assessment questionnaires on neck disability, neck and arm pain intensity. Improvements were seen in all categories, regardless of the surgical procedure, but results tended to be at least slightly better in patients with disc replacements.

An important area, according to Delamarter, was patient satisfaction with the procedure. Four years after surgery, nearly 88 percent of disc replacement patients reported that they were very to completely satisfied, compared with 76 percent of fusion patients. When asked if they would undergo the same surgery again, 89 percent of disc replacement patients and 81 percent of fusion patients said yes.

"While the results of this 13-center study are preliminary, it appears that artificial disc replacement surgery compares favorably as an effective procedure, is preferred by patients and slows the rate of adjacent-level disease," Delamarter said.

Spinal fusion has been recognized as one of the more expensive surgical procedures. The second study looked at costs and is believed to be the first to compare those of three-level disc replacement with three-level fusion. It evaluated itemized billing records of 53 patients undergoing surgery for three consecutive discs of the low back (lumbar spine) at St. John's Health Center in Santa Monica, Calif., where Delamarter practiced before joining Cedars-Sinai.

Total hospital costs for patients undergoing disc replacement surgery averaged 49 percent lower than those for fusion patients.

The number of fusions for low back pain is rising rapidly, but Delamarter urges hospitals, insurers and surgeons to consider alternatives, including total disc replacement.

"After safety and effectiveness of a procedure have been documented, cost is an important consideration," he said. "Artificial disc replacement technology appears to offer a promising, cost-saving alternative to fusion, especially for patients with disease at three levels."

The artificial discs implanted in these studies -- the ProDisc-C and ProDisc-L -- were manufactured by Synthes USA Products. Delamarter and his colleagues have evaluated outcomes and written about the devices since the FDA approved them for research and limited use in the United States. Delamarter is a consultant for Synthes and receives royalties on the ProDisc devices. However, he does not receive royalties on devices used for his patients or any other patients at Cedars-Sinai Medical Center.

read this story online

Monday, March 26, 2012

Becker's ASC Review June Meeting to Gather 700 Industry Leaders to Discuss Orthopedics, Spine, ASC Profitability


Becker's ASC Review will host more than 700 surgery center industry leaders at its annual meeting June 14-16, 2012, at the Westin on Michigan Avenue in Chicago.

Chicago, Illinois (PRWEB) March 25, 2012 

Becker's ASC Review will host more than 700 surgery center industry leaders at its annual meeting June 14-16, 2012, at the Westin on Michigan Avenue in Chicago.
The orthopedic, spine and pain-focused ASC conference brings together surgeons, physician leaders, administrators and ASC business and clinical leaders to discuss how to improve your ASC and its bottom line and how to manage challenging clinical, business and financial issues.
The conference will feature 30 presentations from physician leaders, including: 
  • Everything You Need to Know to Successfully Perform Spine Surgery in an ASC – Ken Pettine, MD, Founder of The Spine Institute and Loveland Surgery Center
  • Evolving Clinical Developments in Interventional Pain Management – Mark Coleman, MD, CEO, National Spine and Pain Centers, LLC
  • Hand Surgery – Key Business Issues for ASCs and Physician-Owned Hospitals – R. Blake Curd, MD, Board Chairman, Surgical Management Professionals
  • Emerging Orthopedic Procedures in ASCs – Business and Clinical Issues – Michael Redler, MD, The OSM Center
Attendees will also have the chance to see a variety of presentations on improving profitability, featuring speakers such as Nancy Boyd of Crane Creek Surgery Center; Luke Lambert, of Ambulatory Surgical Centers of America; Jeff Leland of Blue Chip Surgical Center Partners; Tom Mallon of Regent Surgical Health; Kenny Hancock of Meridian Surgical Partners; Andrew Hayek of Surgical Care Affiliates; Robert Zasa of ASD Management; Charles Peck of Health Inventures; Steve Arnold, MD, of Access MediQuip; and Larry Taylor of Practice Partners.
Keynote speakers for the conference include Lou Holtz, legendary football coach and analyst for ESPN; Tucker Carlson, contributor to FOX News and editor-in-chief of The Daily Caller; and Sam Donaldson, ABC News veteran.
To register, visit: 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference
For information on sponsorship opportunities, contact Jessica Cole at Jessica(at)beckershealthcare(dot)com or call (312) 929-3621.
About Becker’s ASC Review
Becker's ASC Review features general business, legal and clinical guidance for surgery center administrators, physicians and industry leaders. Each of the magazine’s nine annual print issues reaches a qualified audience of more than 25,000 key business leaders and focuses on topics such as joint ventures, development and expansion, regulatory and compliance issues and methods to increase surgery center profitability. Every surgery center in the nation receives Becker’s ASC Review.

Friday, March 23, 2012

The Most Interesting 2.5 Days in the ASC & Spine Business Are Coming — The 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference

by the Staff at Becker's ASC Review

This conference includes great spine, orthopedic and pain management physician leaders as speakers. These include speakers such as Charles Gordon, MD, of Texas Spine and Joint Hospital; David Rothbart, MD, of Spine Team Texas; Richard Wohns, MD, of South Sound Neurosurgery; Scott Glaser, MD, of Pain Specialists of Greater Chicago; Kenneth Pettine, MD, of The Spine Institute and Loveland Surgery Center; Brian Cole, MD, of Rush University Medical Center; Laxmaiah Manchikanti, MD, of the American Society for Interventional Pain Management Physicians; John Caruso, MD, of Parkway Surgery Center; John Peloza, MD, of the Center for Spine Care; and James T. Caillouette, MD, of Hoag Orthopaedic Institute will all lead informative sessions about the biggest ideas, challenges and trends in spine, orthopedics and pain management. 

The conference also includes incredible speakers on improving profitability in ASCs such as Nancy Boyd of Crane Creek Surgery Center; Luke Lambert, of Ambulatory Surgical Centers of America; Jeff Leland of Blue Chip Surgical Center Partners; Tom Mallon of Regent Surgical Health; Kenny Hancock of Meridian Surgical Partners; Andrew Hayek of Surgical Care Affiliates; Robert Zasa of ASD Management; Charles Peck of Health Inventures; Steve Arnold, MD, of Access MediQuip; Larry Taylor of Practice Partners in Healthcare; Larry Teuber, MD, of Medical Facilities Crop.; Michael J. Lipomi of Surgical Management Professionals; Gregory DiConciliis of Boston Out-Patient Surgical Suites; John Seitz of Ambulatory Surgical Group; and Edward Hetrick of Facility Development & Management. 

The conference will be held in Chicago, June 14 through June 16, at the Westin Hotel on Michigan Avenue. Key note speakers are legendary football coach Lou Holtz, editor-in-chief of The Daily Caller and Fox News contributor Tucker Carlson and ABC News veteran Sam Donaldson.

To learn more and register, click here.

view the article online here

Thursday, February 9, 2012

Dr. Kenneth Pettine Named to Becker's list of Spine and Neurosurgeon Inventors to Know

20 Spine and Neurosurgeon Inventors to Know

Written by Laura Miller | February 08, 2012 | Becker's Orthopedic, Spine, and Pain Management Review


Here are 20 spine and neurosurgeons currently in practice who invented spinal devices, techniques and systems.

Edward Benzel, MD (Cleveland Clinic, Cleveland). Dr. Benzel holds at least nine patents for devices, including a cervical spine stabilization method and system and a spinal column retaining apparatus. He is chairman of the Cleveland Clinic's department of neurosurgery. His clinical interests focus on spinal disorders, complex spine instrumentation and spine tumors. He is one of the founding members of the Lumbar Spine Research Society, which formed in 2007. He is chairman of the review board for the Journal of Neurosurgery: Spine and has reviewed for Spine, The Spine Journal and other publications. Dr. Benzel is medical co-director of the Cleveland Clinic Foundation Spine Research Laboratory. Dr. Benzel earned his medical degree from the Medical College of Wisconsin in Milwaukee, where he also completed his residency in neurosurgery. He received fellowship training in spine surgery and spinal cord injury at VA Medical Center in Albuquerque.

Scott Boden, MD (Emory Healthcare, Atlanta). Dr. Boden holds at least six different patents for medical devices and his research focuses on spine fusion, spinal disorders and bone regeneration. He is the director of Emory Healthcare's orthopedics and spine center as well as chairman and founder of the National Spine Network. More than 150 of Dr. Boden's journal articles have been published, and he has authored or edited more than 42 book chapters and nine books on spine topics. His research on the fundamental mechanisms of bone growth and regeneration has been awarded by the American Academy of Orthopaedic Surgeons, North American Spine Society, International Society for Study of the Lumbar Spine and other professional organizations. He earned his medical degree at University of Pennsylvania School of Medicine in Philadelphia, completed an internship at George Washington University Medical Center in Washington, DC, and received fellowship training at Case Western Reserve University Hospital in Cleveland.

Robert S. Bray, Jr., MD (Diagnostic and Interventional Spinal Care, Marina del Rey, Calif.). Dr. Bray has contributed to more than 20 patents, including a cervical dynamic stabilization system, SmartPlate spinal implant and a slidable bone plate system. He is the founding director and CEO of his practice, Diagnostic and Interventional Spine Care. He was chief of neurosurgery for the U.S. Air Force at David Grant Medical Center in 1989 and the founding director of the Institute for Spinal Disorders at Cedars-Sinai Medical Center in Los Angeles. Dr. Bray has served as spine consultant for the U.S. Men's volleyball team and the Oakland Raiders, among other professional athletic organizations. After he received his medical degree from Baylor College of Medicine in Houston, Dr. Bray completed his residency at Baylor Affiliated Hospitals, also in Houston.

James Lloyd Chappuis, MD (Spine Center Atlanta). Dr. Chappuis is in private practice at Atlanta Spine Center and holds patents for several spine devices, including an internal pedicle screw insulator apparatus and facet fusion system. Additional patents are pending for devices such as the Doppler retractor and a modular lumbar interbody fixation system. Dr. Chappuis is a member of several professional societies, including North American Spine Society and American Academy of Orthopaedic Surgeons. In addition to his clinical work, Dr. Chappuis has authored several papers on spinal surgery and served as a clinical instructor at The Medical College of Georgia in Augusta. Dr. Chappuis earned his medical degree at The Medical College of Ohio in Toledo and completed his residency in orthopedic surgery at Campbell Clinic/University of Tennessee. His additional training includes the AO Spine Fellowship where he studied in Karlsbad, Germany.

Kingsley R. Chin, MD (Institute for Modern & Innovative Spine Surgery, Ft. Lauderdale, Fla.). Dr. Kingsley is the founding spine surgeon at the Institute for Modern & Innovative Spine Surgery and inventor of the FacetFuse Minimally Invasive Screw System and MANTIS minimally invasive pedicle screw system for spinal fusion. During his career, Dr. Chin served as the chief of spine surgery at the University of Pennsylvania in Philadelphia and has published several articles in professional journals. He is a diplomat of the National Board of Medical Examiners and American Board of Orthopaedic Surgeons. He earned his medical degree at Harvard University in Boston and completed the Harvard Combined Orthopaedic Residency with Massachusetts General Hospital in Boston. His additional training includes a fellowship in adult reconstructive surgery at Harvard and a fellowship in spine surgery at Case Western Reserve University in Cleveland.

Charles R. Gordon, MD (Texas Spine and Joint Hospital, Tyler). Dr. Gordon has contributed to the development of several patented devices, including an artificial functional spinal unit system and an expandable articulating intervertebral implant. He founded the device company Flexuspine along with his practice, Gordon Spine Associates, based in Tyler, Texas. He is a co-founder of Texas Spine and Joint Hospital and a member of the North American Spine Society and American Association of Neurological Surgeons, among other professional organizations. He received his medical degree from Baylor College of Medicine in Houston and completed his residency and fellowship at The Medical College of Virginia.

Regis W. Haid, Jr., MD (Atlanta Brain and Spine Care, Atlanta). Dr. Haid holds multiple patents for implants used during cervical lateral mass plating, anterior cervical plating, posterior and transforaminal lumbar interbody fusion and cervical arthroplasty. He is a founding partner of Atlanta Brain and Spine Care and medical director of the Piedmont Spine Center and neuroscience service line at Piedmont Hospital in Atlanta. Dr. Haid has traveled internationally to present at spine conferences, including visits to Italy, Russia and Switzerland. He was previously the staff neurosurgeon for the U.S. Air Force at Wilford Hall Medical Center in San Antonio. Dr. Haid earned his medical degree from West Virginia University in Morgantown, where he also completed his neurosurgical residency. He received fellowship training in spinal disorders at the University of Florida College of Medicine.

Ken Y. Hsu, MD (St. Mary's Spine Center, San Francisco). Dr. Hsu is co-inventor – with James F. Zucherman, MD, also at St. Mary's — of the X Stop Interspinous Process Decompression System, which alleviates the symptoms of lumbar spinal stenosis. The process, FDA-approved in 2005, was first in the category of interspinous process devices. Dr. Hsu, who holds 43 patents, has been the director of spine surgery at St. Mary's Medical Center since 1988 and is a member of the clinical faculty at Stanford University. He received his medical degree from State University of New York, completed a residency in general surgery at Mt. Zion Hospital in San Francisco and an orthopedic surgery residency at St. Mary's. He completed a fellowship in spine and pediatric orthopedic surgery at the University of Hong Kong.

A. Jay Khanna, MD (Johns Hopkins Medical Center, Baltimore). Dr. Khanna is an associate professor of orthopaedic surgery and biomedical engineering at the Johns Hopkins University and holds patents for an orthopedic screw system and universally deployable and expandable bone and screw anchor assembly. He currently serves on the clinical teams of BOSS Medical and Cortical Concepts, two companies that he co-founded with his colleagues and biomedical engineering students from Johns Hopkins to foster the development of new orthopedic technologies. Dr. Khanna previously served as the Clinical Director of the Johns Hopkins Center for Bioengineering, Innovation and Design (CBID) which prepares graduate and undergraduate biomedical engineering students to become leaders in the medical device industry and creates collaborations between clinicians and engineers at Hopkins to develop new technologies and companies. Dr. Khanna has a special interest in treating patients with cervical spinal disorders and the use of minimally invasive techniques for the treatment of lumbar spinal disorders. He is a member of North American Spine Society and American Academy of Orthopaedic Surgeons. In addition to his clinical practice, Dr. Khanna has research interests in minimally invasive spine surgery and spinal biomechanics. He earned his medical degree at the Georgetown University in Washington, D.C., and completed his residency at Johns Hopkins. His additional training includes a fellowship spine surgery in the departments of in orthopedic and neurosurgery at the Cleveland Clinic.

Jeffrey A. Kozak, MD (Foundren Orthopedic Group, Houston). Dr. Kozak is a spine surgeon with Foundren Orthopedic Group and has a special interest in performing anterior procedures. He helped design several spinal implants and holds a patent for a spinal fixation device he invented. During his career, Dr. Kozak served on the Texas Workers' Compensation Task Force and authored several professional articles on spine surgery. He is a founding member and past president of the Texas Spine Society and member of the North American Spine Society. Dr. Kozak earned his medical degree from Baylor College of Medicine in Houston, where he also completed his residency in orthopedic surgery. His additional training includes spinal fellowships in England, France and Germany.

Casey K. Lee, MD (Spine Care and Rehabilitation, Roseland, N.J.). Dr. Lee is a spine surgeon with Spine Care and Rehabilitation and founder of Nexgen Spine, which developed the Physio-L Artificial Disc. He serves as chairman and chief medical officer of Nexgen Spine and continues his interest in the development of artificial disc prostheses. During his career, Dr. Lee has served as president of the North American Spine Society and New Jersey Orthopaedic Society as well as co-founder of the Korean American Spine Society. He has authored several papers published in spine text books and peer-reviewed journals. Dr. Lee earned his medical degree from Kyungpook National University Medical School in Korea and completed his orthopedic surgery residency at Carney Hospital/Boston City Hospital in Boston. In addition to his clinical work, Dr. Lee spent time as a professor of surgery at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in Newark.

Isador Lieberman, MD (Texas Back Institute, Plano). Dr. Lieberman holds multiple patents for his technological innovations, including SpineAssist, a robotic tool he recently co-developed for use during minimally invasive spine surgery. He has held appointments with Cleveland Clinic as staff surgeon and professor of surgery at Cleveland Clinic Lerner College of Medicine. His developments have been recognized with awards from Cleveland Clinic and the Spine Society of Europe. He recently co-founded the Uganda Charitable Spine Surgeon Mission, with which he accompanies a team of surgeons to visit Uganda each year to treat the underprivileged with spine conditions. He earned his medical degree from the University of Toronto in Ontario, Canada, and completed his residency at Mount Sinai Hospital in Toronto. He also completed residency programs in orthopedic surgery at two Toronto hospitals along with a clinical fellowship in spine and trauma surgery at The Toronto Hospital.

David W. Lowry, MD (The Brain+Spine Center, Holland, Mich.). Dr. Lowry is a neurological spine surgeon with The Brain+Spine Center and co-founder of TransCorp Spine. He continues to serve as a board member of the company. During his career, Dr. Lowry invented a new spine surgery technique, the TransCorporal Micro Discectomy, for patients suffering from spinal stenosis. He holds two patents for his work and continues his efforts in research and development in areas such as the cervical spine. Dr. Lowry is a member of North American Spine Society and Congress of Neurological Surgeons. He also serves on the board of trustees for Hope College, his alma mater. Dr. Lowry earned his medical degree at Johns Hopkins Medical School in Baltimore and completed additional training at the University of Pittsburgh.

Robert Masson, MD (NeuroSpine Institute, Orlando). Dr. Masson is the founder and president of NeuroSpine Institute and a retired Lieutenant Commander of the United States Naval Reserve. He has a professional interest in minimally invasive spine surgery and developer of the iMAS surgical principles, techniques and products for Synthes Spine. The iMAS is an interpedicular minimal access surgery of the lumbar spine. During his career, Dr. Masson has treated several professional athletes, including football and basketball players. In addition to his clinical practice, Dr. Masson is a member of the Society for Minimally Invasive Spine Surgery. He was also featured on a Discovery Health documentary as a neurological surgery expert. Dr. Masson earned his medical degree at the University of Florida and completed his neurological surgery residency in Gainesville, Fla. His additional training includes a fellowship in skull base surgery and neurotology at the House Ear Clinic in Los Angeles.

Seth Neubardt, MD (Seth Neubardt, M.D. & Jack Stern, M.D., Ph.D., White Plains, N.Y.). Dr. Neubardt is the sole inventor of several medical patents, including one for a spinal procedure to safely insert screws which is now used at more than 25 hospitals in 15-plus countries. He has a professional interest in developing technology for minimally invasive spine surgery, such as an electrically insulated surgical probing tool and an apparatus and method for locating defects in bone tissue. He is a fellow with the American Academy of Orthopaedic Surgeons and member of the North American Spine Society. Dr. Neubardt earned his medical degree from the University of Texas Medical School at Houston and completed his residency in orthopedic surgery at Montefiore medical Center and Albert Einstein College of Medicine in New York City. His additional training includes an orthopedic and neurological spine fellowship at New York University Medical Center in New York City.

Kenneth A. Pettine, MD (Rocky Mountain Associates, Loveland, Colo.). Dr. Pettine is co-inventor and co-designer of the Maverick Artificial Disc, a disc replacement device for the neck and back. He is a co-founder of Rocky Mountain Associates and a surgeon at Loveland (Colo.) Surgery Center. During his career, Dr. Pettine has been chief investigator for eight FDA studies involving non-fusion spine technology. He is a distinguished speaker at national and international symposiums and the author of nearly 20 research publications. He received his medical degree from the University of Colorado School of Medicine in Denver. He completed his residency and his master's degree in orthopedic surgery at the Mayo Clinic in Rochester, Minn., and completed a fellowship at the Institute for Low Back Care in Minneapolis.

David G. Schwartz, MD (OrthoIndy Northwest, Indianapolis). Dr. Schwartz is the inventor of the Anteres Spinal Instrumentation System, which is used for the treatment of spinal fractures, scoliosis and tumors. During his career, Dr. Schwartz's clinical interests include spinal deformities, kyphosis, scoliosis and low back pain. He is the director of OrthoIndy's Spine Fellowship and an assistant clinical professor in the department of orthopedic surgery at Indiana University in Bloomington. He earned his medical degree from Loyola University in Chicago, completed a residency in orthopedic surgery at Northwestern University in Chicago and received fellowship training in spine surgery at the Leatherman Spine Center, Kosair Childrens Hospital and the University of Louisville, all located in Louisville, Ky.

Jeffrey Wang, MD (UCLA Comprehensive Spine Center, Los Angeles). Dr. Wang practices with the UCLA Comprehensive Spine Center and is the director of the UCLA Spine Surgery Fellowship. He is the inventor of an artificial disc, which he used in a spine surgery for Governor Benigno R. Fitial, who was suffering from spinal stenosis. During his career, Dr. Wang has served on the editorial boards for several professional journals, including editor-in-chief for Global Spine Journal and deputy editor for The Spine Journal. He has served on the board of directors for the Cervical Spine Research Society and North American Spine Society as well as held leadership positions with the American Academy of Orthopaedic Surgeons. In addition to his clinical work, Dr. Wang runs a basic science laboratory. His research interests include gene therapy for spinal disorders, minimally invasive spine surgery and bone growth biological proteins. He earned his medical degree at the University of Pittsburgh School of Medicine and completed his residency in orthopedic surgery at UCLA School of Medicine. Dr. Wang's additional training includes a spine and spinal cord injury fellowship at University Hospitals of Cleveland.

Anthony T. Yeung, MD (Desert Institute for Spine Care, Phoenix). Dr. Yeung developed the FDA-approved Yeung Endoscopic Spine System, and was one of the first spine surgeons to utilize endoscopically-guided laser for degenerative conditions of the lumbar spine. During his career, Dr. Yeung has authored more than 70 scientific publications on his technique. He is currently the president of the World Congress of Minimally Invasive Spine Surgeons and has held leadership positions within numerous other national and international spine organizations. Dr. Yeung received his medical degree from University of New Mexico School of Medicine in Albuquerque, completed his residency at Maricopa County General Hospital in Phoenix and served in the U.S. Navy Medical Corp in Subic Bay, Philippines.

Jim Zucherman, MD (San Francisco Orthopaedic Surgeons). Dr. Zucherman is a senior spine partner at San Francisco Orthopaedic Surgeons Medical Group and inventor and co-developer of the X-Stop, an interspinous process device for treating lumbar spinal stenosis. He is also in the process of developing the Starflex motion preservation minimally invasive spine stabilization device through Spartek. During his career, Dr. Zucherman has pioneered several surgical techniques and developed one of the first laparoscopic lumbar spinal fusions and percutaneous cervical discectomy procedures in the United States. He has been a principle investigator for the Prodisc and Flexicore FDA lumbar disc replacement trials as well as the Prestige and Cervicore cervical disc replacement trials. Dr. Zucherman earned his medical degree at Baylor College of Medicine in Houston and completed his residency in orthopedic surgery through the San Francisco Orthopaedic Residency Program. His additional training includes a pediatric and orthopedic spine surgery fellowship at the Duchess of Kent Children's Orthopaedic Hospital of the University of Hong Kong.