Stryker buys Vertos

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lobelsteve

lobelsteve

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Who gets the big payout? I mean, which Kel upgrades their shoes from this.
Members don't see this ad.
 
I honestly thought Boston Sci was going to purchase them. bet they're gonna regret buying Intracept.
 
Members don't see this ad :)
I agree on that point. They spent all that money just a few months before competitors come onto the market.
 
I think the last round of Vertos investors will do pretty well. It was $25M just a couple years ago. The early rounds have all lost compared to investing in the total market, I would assume.
 
Vertos needs that T code to go away ....
 
The T code certainly makes me nervous. I can't ever get a clear answer from anyone on what exactly it means and is it a higher risk of a clawback or not. I know that Medicare is using it as a trial code and collecting data on it but I would agree that a lot of places would feel more comfortable doing the case with a regular CPT code
 
The T code is superior because it guarantees payment while active.

Once it has its own CPT code it will be denied as experimental or have a host of requirements and hoops to get approval.
 
agree with agast. its a trial code. means that we get paid.

reps prefer a dedicated code, because it signals acceptance by CMS. their job is secure. but not our $$$.
 
The T code for mild isn’t consequential because of the NCD. That’s what makes it so easy to get approved for any Medicare or Medicare advantage patient (99% of ideal mild candidates are Medicare aged patients)

T codes have a time limit

I believe MILD’s 0275T is coming up to committee soon and discussion of switching to Cat 1 code will then be had.

My understanding from multiple sources is that the NCD will remain with the procedure even with a Cat 1 code.

FYI Spine Surgeon LinkedIn is blowing up with hate towards Stryker for buying Vertos lol
 
They have difficulty accepting that the world doesn’t revolve around them. Pain docs have more and more control of the process than ever. Partly it is their fault encouraging/demanding that their referrals all be fully teed up for surgery. Which leads the primary care to just send to a pain doc to do and most of those patients never make it to the surgeon. But that isn’t a bad thing for the patients or the system long term.
 
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gaspasser127 said:
The T code for mild isn’t consequential because of the NCD. That’s what makes it so easy to get approved for any Medicare or Medicare advantage patient (99% of ideal mild candidates are Medicare aged patients)

T codes have a time limit

I believe MILD’s 0275T is coming up to committee soon and discussion of switching to Cat 1 code will then be had.

My understanding from multiple sources is that the NCD will remain with the procedure even with a Cat 1 code.

FYI Spine Surgeon LinkedIn is blowing up with hate towards Stryker for buying Vertos lol
Click to expand...
LOL please link some of these posts for our amusement.
Its not showing up on my feeds.
 
gaspasser127 said:
FYI Spine Surgeon LinkedIn is blowing up with hate towards Stryker for buying Vertos lol
Click to expand...
My initial thought was that Stryker bought them to kill the device and get more surgeon love.
 
What are the pro and facility fees like for mild?
I have zero intention to ever do this, but figure it’s decent given how hard other local pain docs push it.
 
SpineandWine said:
No, Stryker rep promoting it as an option
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Its the only device/therapy in its class as long as they have the T code and maintain its patent. As soon as its approved with its category 1, I expect generics will come on board and undercut Vertos by a wide margin. The actual cost of the kit is about $150-$200 bucks and is being sold at 2k-2.2k. Huge margin.
 
Status Sciaticus said:
LOL please link some of these posts for our amusement.
Its not showing up on my feeds.
Click to expand...

www.linkedin.com

#stryker | Lali Sekhon, MD PhD MBA | 49 comments

How to win friends and influence people. Stryker buys the company that bought us the MILD procedure. So many spine surgeries see this gimmicky procedure performed by pain docs that we subsequently revise. Stryker's customer base is spine surgeons not pain docs. It will be interesting to see...
www.linkedin.com www.linkedin.com
 
Very interesting thread to read. It struck me that the spine surgeons don’t realize Stryker has a portfolio of equipment for other specialties. RFA and kyphoplasty for pain docs of course, but orthopedic joint surgery as well.

I asked my spine surgeon why he wasn’t interested in minimally invasive endoscopic spine surgery. He was sort of negative towards that territory in terms of how much you actually visualize and accomplish.
 
gaspasser127 said:
www.linkedin.com

#stryker | Lali Sekhon, MD PhD MBA | 49 comments

How to win friends and influence people. Stryker buys the company that bought us the MILD procedure. So many spine surgeries see this gimmicky procedure performed by pain docs that we subsequently revise. Stryker's customer base is spine surgeons not pain docs. It will be interesting to see...
www.linkedin.com www.linkedin.com
Click to expand...

gaspasser127 said:
Here’s another one

www.linkedin.com

#orthopedicsurgery #neurosurgery #spinesurgery #endoscopicspine… | Jahangir 'John' Asghar, MD | 78 comments

Now that Stryker has purchased Vertos Medical can we do a real comparative study of the MILD procedure and follow up MRI studies, as well. It would help alleviate the concerns about its efficacy and the rumors of malfeasance, bullying and burying of negative data…. As a doubter, I have...
www.linkedin.com www.linkedin.com
Click to expand...
Please keep adding/contributing.
I do love spine surgeon's tears of sadness oh so much
 
If you think it’s a sham procedure that only delays appropriate medical care, you’d be pretty upset. Especially if there’s a financial incentive with surgical-level codes
 
bedrock said:
I don’t understand why spine surgeons would get their panties in a bunch over MILD?

I refer patients for MILD only after Spine surgeon/anesthesia deny a lami.

So MILD shouldn’t threaten surgeons. If they’ll actually do the surgery, I’d prefer these patients get a lami.
Click to expand...
I think you’re the exception to the typical scenario that occurs in pp. these patients don’t generally make it to a surgeon til they’ve gotten mild and a spacer… sold to them as “less invasive”. I know I see a biased sample…. But I get several consults per month for 2nd opinions after having mild…. Who I then refer to a surgeon for a decompression which can generally be done endoscopically.
 
Agast said:
If you think it’s a sham procedure that only delays appropriate medical care, you’d be pretty upset. Especially if there’s a financial incentive with surgical-level codes
Click to expand...

Maybe different in your area. In mine, surgeons don’t mind if you do MILD, as long as the patient is first given a surgical consult
 
bedrock said:
Maybe different in your area. In mine, surgeons don’t mind if you do MILD, as long as the patient is first given a surgical consult
Click to expand...
Ah, but you don’t do the MILD yourself because you didn’t see good outcomes. So does it “work?” I guess technically because it’s still in trial mode, there’s no proof, just anecdata. I think the theory behind it is sound but I’m curious if after the trial ends, Stryker discovers they purchased something DOA.
 
bedrock said:
Maybe different in your area. In mine, surgeons don’t mind if you do MILD, as long as the patient is first given a surgical consult
Click to expand...
People who work in ortho centers with spine surgeons have different thought process than PP stand alone pain clinics who don’t have good relationship with spine surgeons
 
Agast said:
If you think it’s a sham procedure that only delays appropriate medical care, you’d be pretty upset. Especially if there’s a financial incentive with surgical-level codes
Click to expand...
Data suggests otherwise. I've definitely done several that have helped patients avoid surgery.
People also assume that surgery delay is the main pain point (pun intended).
Several patients also prefer not to undergo spine surgery, but even more so who have co-morbid conditions that makes general anesthesia dangerous.

Spine surgeons are just butt-hurt that the procedure might actually help people and they would lose that business and the $$$$ from the lami and decompression and they wouldnt get to send out an SOS and juice the vig in their ASCs (paging Dr. Russo)

www.ncbi.nlm.nih.gov

The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long‐term follow‐up

Minimally invasive lumbar decompression (mild [®] ) has been shown to be safe and effective for the treatment of lumbar spinal stenosis patients with hypertrophic ligamentum flavum as a contributing factor. This study examines the long‐term ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
www.vertosmed.com

Percutaneous Image-Guided Lumbar Decompression for LSS

This study compares outcomes for percutaneous image-guided lumbar decompression (PILD) using the [mild] Procedure to outpatient laminectomy.
www.vertosmed.com www.vertosmed.com

gdub25 said:
It is no different for us when CRNA's or family medicine doctors calling themselves pain specialist and start doing injections with no training. Everyone gets worked up over scope of practice creep when it affects the yet still do it themselves where it benefits them.
Click to expand...

It would be more apt to compare CRNA vs anesthesiologists doing anesthesia. Both are trained to provide anesthetics but one is more trained and skilled to do it.

Similarly, both pain physicians and neurosurgeons are trained to provide interventional/minimally invasive pain relief interventions, just that one is more trained and skilled to do it. However, theres not enough neurosurgeons to go around, even less so that do minimally invasive procedures.
 
gaspasser127 said:
The T code for mild isn’t consequential because of the NCD. That’s what makes it so easy to get approved for any Medicare or Medicare advantage patient (99% of ideal mild candidates are Medicare aged patients)

T codes have a time limit

I believe MILD’s 0275T is coming up to committee soon and discussion of switching to Cat 1 code will then be had.

My understanding from multiple sources is that the NCD will remain with the procedure even with a Cat 1 code.

FYI Spine Surgeon LinkedIn is blowing up with hate towards Stryker for buying Vertos lol
Click to expand...

CAT 1 code is being discussed at AMA CPT committee in September. Many surgical societies are lining up against it. There will be some backroom bartering: "I'll trade you Cat 1 for MILD for directionality on SIJ fusion, etc." That's how the sausage gets made. Hopefully, they ask for site of service 11 for the MILD Cat 1 code...
 
Mild should be office based for sure. Bad business model for Stryker though

Still haven’t found 3 patients in my practice that need SI joint fusion to do the painteq training for office based. Only treat 1000ish joints a year though so maybe not enough pathology in my area..

Lots of toys for pain docs these days not certain about benefit to patients
 
Stryker is already serving pain docs in office with kypho and RF

If they allow MILD to be done in office that’s a big win for Stryker

I’m not buying all this cynicism around Stryker’s decision to buy Vertos. Their next step will likely be Nevro which gets them into both SCS as well as SIJ business.

Will be expensive to run a stim company though
 
gaspasser127 said:
Stryker is already serving pain docs in office with kypho and RF

If they allow MILD to be done in office that’s a big win for Stryker

I’m not buying all this cynicism around Stryker’s decision to buy Vertos. Their next step will likely be Nevro which gets them into both SCS as well as SIJ business.

Will be expensive to run a stim company though
Click to expand...
From what I heard, Nevro floated the idea of a direct sale to them, but Stryker declined it, citing market saturation and declining reimbursements.
 
gdub25 said:
Declining reimbursement? Stim reimbursement has done nothing but go up every year for the last decade.
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I imagine relative to opex. No doubt their costs have been increasing, based on their earnings call.
Plus its hard for a 300M company to compete with companies that are 200B in market cap.

Perhaps declining profit margin would've been a more apt phrase.
 
I think it makes sense for Stryker
Structural option
CS and rep support but no long term patient contact needed
Surgeon's may start doing it themselves or just train up their pain-monkey to do it as a gateway to a bigger decompression/fusion
 
There is a local neurosurgeon that does them. I was surprised when I saw he had a few on the board at an ASC
 
its how and who you market it to and how you work things out with surgical colleagues.

i am getting referrals from neurosurgery and ortho spine for MILD instead of decompressive lamis.
 
There’s no RVU assigned but there is a pro fee

If you’re RVU based you just have to negotiate with your health system what the assigned RVU for it should be

At my previous health system it was 9

At my current one it is 12
 
Ducttape said:
its how and who you market it to and how you work things out with surgical colleagues.

i am getting referrals from neurosurgery and ortho spine for MILD instead of decompressive lamis.
Click to expand...
youre getting surgeons who were referring decompressive lamis to you?
 
no, for MILD so they dont have to do a decompressive lami on a 90 year old, or a multilevel fusion on an 85 year old. got one today.

keeping fingers crossed they get some benefit. fwiw, have done a few under local without any sedation due to underlying health issues.
 
Ducttape said:
no, for MILD so they dont have to do a decompressive lami on a 90 year old, or a multilevel fusion on an 85 year old. got one today.

keeping fingers crossed they get some benefit. fwiw, have done a few under local without any sedation due to underlying health issues.
Click to expand...

MILD is very doable under local only

Just numb up the tract and drop a ton of local onto the lamina
 
I was able to negotiate a wrvu value of 13 at our HOPD. All are done with local with minimal sedation in office suite. Our conservative neurosurgeons send patients for it, the other NS scoffs at it lol
 
Ducttape said:
no, for MILD so they dont have to do a decompressive lami on a 90 year old, or a multilevel fusion on an 85 year old. got one today.

keeping fingers crossed they get some benefit. fwiw, have done a few under local without any sedation due to underlying health issues.
Click to expand...
I doubt it is that altruistic…. I’d think most likely because they can fill their OR schedule with patients with commercial insurance.
 
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