Spinal fusions, millions in Medtronic royalties look fishy

Compared with other hospitals in the U.S., Norton Hospital in Louisville, Ky., ranks No. 3 in total number of spinal fusion surgeries performed between 2004 and 2008, according to the Wall Street Journal. Is it a coincidence, then, that five surgeons who were paid a combined total of more than $7 million this year by medical device maker Medtronic happen to work at that hospital?

To corporate whistleblower and congressional critics, such arrangements look like kickbacks to fuel medical device sales. They contend that overuse of surgical devices is behind the spiraling costs of Medicare.

The surgeons--Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno--received over $7 million in the first nine months of 2010. The money came from Medtronic, mostly in royalties for helping the company design spine products.

For Medtronic, spinal fusions are big business, bringing in $3.5 billion in sales--roughly half the total spinal implant market. Screws used to drill into bone can sell for up to $2,000 each, but cost just $100 to make.

Medtronic claims it can't design new medical products without the help of surgeons, and says the royalties are legit. But it doesn't provide detailed information on each surgeon's contribution to the product. The manufacturer does not pay surgeons royalties on devices they use in their patients, thereby removing any financial incentive for them to do more surgeries than necessary, the Journal reports.

At Norton, one-quarter of spinal fusions between 2004 and 2008 were performed on patients who suffered from only aging disks--also known as degenerative disk disease--compared with 17 percent nationally. The numbers suggest that the surgeons operating at Norton were overzealous in treating disk problems with spinal fusion. One health insurer, Blue Cross and Blue Shield of North Carolina, announced that it would not cover spinal fusions for patients diagnosed with degenerative disk disease, because the procedure is considered "not medically necessary."

Coincidentally enough, Medtronic in past years has been involved in lawsuits over alleged sham consulting agreements with surgeons who took payoffs in exchange for using the spinal-device units products.

To learn more:
- read the Wall Street Journal article

Related Articles:
Medtronic divulges it paid docs over $15.7 million in royalties
SPOTLIGHT: Medtronic says it paid doctor $78800
Suit says Medtronic gave doctors plush gifts
Medtronic CEO defends paid physician consulting contracts