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.

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.

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

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

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.

Read this story online

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.

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.

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.

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.

Spinal fusion surgery: The science behind Manning's life changing operation

By Christi Sodano | Feb 02, 2012 | Medill Reports Chicago

With his home turf the epicenter of the Super Bowl buzz this season, his younger brother in contention for the NFL championship and a potentially life-changing contract decision only one month away, it is little wonder why Peyton Manning’s recovery is at the forefront of Indianapolis conversation.

Last September, Manning underwent his third neck surgery in two years. The controversial spinal-fusion surgery aimed to correct a cervical disc herniation in his neck has been associated with declines in his on-field performance.

Cervical disc herniation occurs when the cushioned discs, which act as shock absorbers between the vertebrae, bulge and pinch the spinal cord or nerve root that are encased in the spine.

This is generally caused by repeated neck motion or trauma and can result in loss of motor function and numbness or sharp pain, said Dr. Selene Parekh, associate professor of orthopedic surgery at Duke University.

Typically surgery is considered only after the patient has endured prolonged pain of up to six weeks, said Dr. Wellington Hsu, assistant professor of orthopedic surgery at the Feinberg School of Medicine at Northwestern University.

In Manning’s case, disc fragments pinching the nerve root in his cervical spine likely caused acute pain and decreased arm strength.

During the September operation, doctors removed a single disc through a small incision in the front of the neck, alleviating pressure on the nerve root and replacing the disc with bone grafts or a plastic implant. Once the new disc is set into place, the surrounding vertebrae are fused using a titanium plate and screws in the upper and lower vertebrae.

Prior to Manning’s spinal-fusion surgery, he underwent two microdiscectomies in an attempt to correct the problem. After a series of diagnostic tests in September showed his recovery was not on track, spinal-fusion surgery became the next step.

Although the surgery is touted by many industry professionals as more than 95 percent successful, Dr. Kenneth Pettine, an American Academy of Orthopedic Surgeons member, said in a 2010 report, “The perception is that this is a great operation. I’m not saying it’s an awful operation. We’re just presenting the data that it’s certainly not 95 percent.”

“When you get one level fused, the next level up and down has to take all the motion. This very often accelerates into adjacent level dysfunction. That can happen two years later, that can happen 10 years later,” said Shaeffer Bannigan, development engineer at NuVasive, Inc., a spinal surgery technology company.

Hsu, who published a study in 2010 about the likelihood of athletes to return to the NFL after spinal- fusion surgery said, “For a player like Manning, the time frame to play football is closing in and when his arm strength was not improving fast enough, he elected to have the fusion.”

In his study, Hsu analyzed 99 players, some of whom are still on the field, and found on average players treated surgically had a higher return-to-play rate and longer career than players who are treated nonsurgically and position was a key factor in success after surgery.

Performance after surgery largely depends on the player's position and is particularly relevant for quarterbacks, Parekh said.

“Loss of function, even if only by a few degrees, is significant because if neck rotation is inhibited, that can affect your ability to assess what is happening on the field,” he said.

Recovery plans after surgery vary depending on the patient.

According to Parekh’s medical-information blog, the bone usually takes 12 weeks to fuse and after fusion, “a prolonged course of therapy will be needed to regain some of the loss of function, mobility and strength.”

Despite a lengthy recovery process, Hsu speculated that, “Manning will be able to come back to the NFL next year. What his level of play will be after he returns is still yet to be determined.”

However, Hsu’s opinion is not shared by all.

“My personal opinion was that there wasn’t an entirely honest view of what was happening him, there is a real chance that he may never return to play in the NFL,” Parekh said.

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