Most back surgery is unnecessary and often harmful. That was the opinion of the late Dr. John Sarno, whose bestselling book “Healing Back Pain” saved millions of patients, including me, from a surgeon’s scalpel to relieve us of pain that was psychological in origin. I’ve previously written about Sarno’s book and why its mandatory reading for anyone considering back surgery.

What’s gnawed on me since reading Sarno’s book some two decades ago is what kind of physician would be attracted to perform back surgery. Doctors are required to take the Hippocratic Oath promising to do no harm, and yet there is considerable evidence that back surgery can make debilitating issues much worse. Logic suggests it would take a take a certain kind of physician to choose the specialty.

Kaiser Health News, a publication that admirably covers healthcare wrongdoing, has highlighted the alleged dishonesty and questionable behavior that’s pervasive among a swath of America’s spine surgeons. In an investigative report so damning I read it three times to make certain I understood it correctly, KHN revealed that many spine surgeons are receiving “sham consulting fees” and other questionable payments that amount to illegal kickbacks.

Kaiser Health News, June 17, 2021

We’re talking about a lot of money here and not just a few isolated incidents. A KHN analysis of government data found that hardware manufacturers of spinal implants, artificial knees, and hip joints showered surgeons with more than $3.1 billion in payments from August 2013 until year-end 2019. Spine surgeons accounted for 25 percent of doctors who accepted more than $100,000 or more of the largesse and two-thirds of those who raked in $1 million or more. The payments came from publicly traded companies, including Medtronic and Johnson & Johnson.

Another alarming KHN disclosure: Kingsley Chin, the founder and principal owner of a spine device manufacturer the Department of Justice has alleged paid more than $8 million in illegal payments to spine surgeons, is a Harvard Medical School graduate who was previously on the faculty of the University of Pennsylvania Medical School. KHN reviewed court pleadings of nine malpractice cases Chin settled while living in Philadelphia and another six in south Florida. Details of the settled cases are confidential. Chin has denied negligence.

KHN said that while spine surgeons are raking in millions in payments from device manufacturers, patient injuries from spine surgeries are on the rise. The news service features some of the victims. Spine surgery is one the fastest growing procedures in medicine. The procedure increasingly is being done at outpatient ambulatory centers where surgeons often have financial interests in the facilities. Spine surgeons “make upward of $500,000” a year according to KHN, and they charge $8,000 to $20,000 for their major procedures.

Worth noting: More than a dozen Dallas hospital administrators and doctors were recently sentenced for accepting “kickbacks” for referring patients to an area hospital. Three of the implicated doctors were spine surgeons.

Having grown up on Marcus Welby, M.D. and Ben Casey, I’m still a babe in the woods when it comes to being shocked that some doctors are possibly on the take, or at least involved in activities that have very bad optics.

I’m learning very quickly.

Last August I reported for Deadline Detroit about how orthopedic surgeons at Beaumont Royal Oak hospital in suburban Detroit were being pressured to use medical devices manufactured by Stryker Corp. they considered inferior. After continually refusing the Stryker devices, Dr. Jeffrey Fischgrund, Beaumont’s associate chief medical officer, mandated that any Beaumont orthopod wanting to use alternative products to Stryker’s needed to get his permission. Fischgrund asked that the requests not be submitted in writing.

Fischgrund’s surgical specialty: He’s a spine surgeon, one who received more than $931,000 from Stryker for consulting and other services since 2013. (Beaumont dropped its Stryker requirement after I reported the story.)

Beaumont, which issued a statement insisting Fischgrund’s Stryker mandate was entirely kosher, had a financial incentive to use the company’s products. Beaumont was to receive a “rebate” if it used Stryker products for 75 percent of its orthopedic trauma surgeries.

Jeffrey Fischgrund

Beaumont also pressured its surgeons to use Johnson & Johnson’s Ethicon stapler, despite many of them believing that a stapler manufactured by Medtronic was superior. Surgeons wanting to use the Medtronic product also needed to get Fischgrund’s approval.

Beaumont gets its supplies from HealthTrust, a so-called group purchasing organization (GPO), which in theory can secure better prices because it buys products in bulk on behalf of hundreds of hospitals. However, studies show that hospitals can often get better prices if they negotiate their own rates. CEOs of major U.S. hospital systems sit on the boards of the most powerful GPOs, often receiving lucrative compensation.

GPOs are legally permitted to accept kickbacks from manufacturers. As industry sources have explained to me, where these kickbacks go and how they are accounted for is anyone’s guess. Beaumont doesn’t release details of its financials, a practice called out last week by former Spectrum Health CFO Michael Freed. Spectrum has announced plans to merge with Beaumont, so the public will likely never know how Beaumont accounted for its Stryker and J&J rebates. I feel safe in speculating that Beaumont patients didn’t financially benefit from them.

HealthTrust last year named Beaumont its “Outstanding Member” for 2020 “for creating extraordinary value by utilizing the company’s initiatives. Beaumont CFO John Kerndl resigned in March to join Beth Israel Lahey Health, another HealthTrust “member.”

The spine surgery business makes it readily apparent why U.S. healthcare is the most expensive and least efficient in the world. Medical device manufacturers are showering surgeons with billions in payments, GPOs take their cut, and hospitals supposedly get a piece of the action. I’m reminded of the opening scene of Goodfellas, where the narrator explains the workings of the mob and all the layers of people who get paid off to make organized crime so profitable.

Frankly, the U.S. healthcare industry doesn’t strike me as all that different.

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