In Search of the Super ACL: How Medicine Is Making Up for Slow Human Evolution


When I injured my ACL in high school (quite some time ago), it ended my aspiring college baseball dreams and beyond; but it began a lifelong medical interest in my injury.  It was the seed of a theory around the ACL that I began cultivating in college, medical school and in my orthopedic training, and now as the head of a surgical implant management company that knows about knee surgeries.  The fact is that the ACL is poorly designed to support the 21st Century human, and instead of waiting for natural human evolution it’s fascinating to see how medicine is stepping up to deliver a super ACL.


My theory is based on the fact that ACL (which stands for the Anterior Cruciate Ligament) injuries and repairs have been increasing at astounding rates across all age demographics, but especially in younger populations.  Overall, there are approximately 400,000 reconstructive surgeries on ACLs per year.  Moreover, consider knee implant increases (often from long standing issues stemming from prior ligament injuries) from 2000 to 2010 among 18- to 44-year-olds at 113%, 45 to 64 at 213%, 65 to 84 at 97%, and 85 and over at 89%.  And costs have increased dramatically along with volume.  The aggregate cost for knee surgeries is projected to show a 10-year increase of 450% to $41 billion by 2015.


The ACL is the primary stabilizer and the smallest of four main ligaments in the knee.  Granted it doesn’t perform a life-sustaining bodily function, but it powers lifestyle-sustaining full mobility in high-demand twisting force movements such as in sports, and even in day-to-day living.  For instance, you know it if the ACL is not doing its job because it can feel as if the knee will give way at any moment (particularly on stairs).


One-directional sports such as swimming, biking and running put less strain on the ACL.  But sports that involve sudden lateral and vertical movements where players can take unexpected hits, such as football, basketball, hockey, soccer, lacrosse, and volleyball, to name a few, demand what I call a super ACL.  And as baby boomers continue their active lifestyles into their sixties and well beyond, they are simply wearing out body parts and requiring replacements. 


All of this leads me to conclude that the ACL is poorly designed to support the 21st Century human.  Perhaps thousands of years from now, humankind will look back on this era in human development and realize that the ACL was at an intersection where human evolution was bridged by medical science. 


Many centuries into the future the ACL may evolve into a super-structure within the knee that lets us pivot harder, jump higher and take unexpected hits in stride.   Or more likely that human modern day “deficiencies” like the ACL will be augmented in different ways, internally and externally, before injuries to suit the physical demands of certain activities.  Today, however, it’s clear that the ACL is not keeping up with us humans and our ever-growing list of activities that start younger and go well into our senior years.  Looking at our active lifestyles through the long lens of human evolution where it’s just been mere decades of change in lifestyle, it’s no wonder the ACL is falling behind. 


That wouldn’t be a first for the 21st century human body.  For example, that small pouch attached to the large intestine called the appendix no longer aids in digestion, and the one in 20 people who have it removed don’t miss it.   Our mouths typically aren’t big enough anymore to accommodate wisdom teeth, so they’re not missed either.  And our coccyx used to be where our tails protruded, but we haven’t missed our tails for quite some time now


As usual, science and medicine are coming to the rescue where natural biological forces can’t keep pace with the demands of human progress.  In general, we’ve seen significant innovative breakthroughs over the past five years. 


As the Smithsonian Magazine recently reported, “In addition to prosthetic limbs, which are more versatile and user-friendly than ever before, researchers have developed functioning prototypes of artificial organs that can take the place of one’s spleen, pancreas or lungs. And an experimental implant that wires the brain to a computer holds the promise of giving quadriplegics control over artificial limbs.”  The Smithsonian article highlighted the work of a team that rebuilt more than 50% of the human body, causing many thought leaders to ask how much of the human body can be replaced and still be considered human.  One thing is clear: we have never been so replaceable. 


What this means is that we’re going to continue to see medical science stepping in to bridge the gap between the fast-paced demands of the 21st century human body and the glacial pace of human evolution. 


These positive advancements are all the more reason why we need to ensure that treatments are effective, affordable and really do provide the improved quality of life that 21st century humans demand.  That means effective preventive, non surgical and surgical management across all patient touch points is essential, including coordination that motivates teamwork among the patient, trainers, doctors, treatment facility, payors and device manufacturers.  It’s by taking a coordinated approach that we can apply best practices, achieve best outcomes, hold down costs, learn and improve for the benefit of patients. 


In other words, as medical science continues to boggle the imagination with positive advancements that bridge the gap between our modern lifestyle demands and our physical shortcomings, we also need to take a thoughtful approach to the prevention and delivery system so that our society and our economy can afford these amazing advancements, and more people can avail themselves of “Super ACLs” and other super body parts today and into the future.  


Becker’s Hospital Review Article

As the nation continues to go through massive changes in health care, I’ve been carrying around some building thoughts and concerns about the the industry I am actively involved with  — the medical device sector — and finally I decided to do something about it and wrote an article focusing on the need for and benefits of fundamental industry disruption in the way things are done in the medical device sector.  I was pleased when one of my favorite industry publications, Becker’s Hospital Review, ran that article yesterday.  
The article details many of the trends that are driving the medical device industry and reinforces the need for all involved – manufacturers, providers, payers and intermediaries — to be proactive in addressing the issues we are facing and together we can.  The gist of the article is that here are tremendous changes on the horizon for the medical device industry, from cost increases and usage growth to quality demands and results-based care measurement.  And while the system doesn’t need to be entirely ripped apart, it certainly could use some disruption to make room for and directly address rapidly changing dynamics. 
To read the article in Becker’s Hospital Review, click here

Consumer Reports Publishes Hospital Rating Systems for Patients


In August, Consumer Reports announced the launch of its Hospital Rating Systems for Patients, a new platform that empowers patients by sharing information on the performance of 4,000 hospitals across the U.S. against important care measures, such as readmissions, infection rates, medical complications and adverse events. Increasingly patients will turn to resources such as Consumer Reports for guidance on making important decisions about who to entrust their healthcare.

Being able to capture, track and analyze data in the healthcare industry is a growing area of opportunity to improve medical outcomes, reduce costs, and increase patient satisfaction, goals of all healthcare providers, payers and patients.

At Access MediQuip, we’ve been at the forefront of this effort for some time now. Our Patient and Device Registry Program, the first and only level 3 Implant Registry in the country, is an example of how powerful quality measures and data analytics can be in improving quality of care and reducing costs.

Earlier this month, URAC, a national accreditation leader, awarded its bronze award for best practices in Healthcare Consumer Engagement and Protection to our company. This prestigious award recognizes our longstanding commitment and continuous efforts towards improving surgical outcomes, which we accomplish through delivering critical information on implantable devices and collaborating with payers and providers to coordinate optimal care for patients.

As CEO of Access Mediquip, I’m honored that our team has been recognized for their efforts on behalf of patients, whose care and well-being we put first.

AMQ Upgrades Partners in Focus Portal

Recently, Access MediQuip made some major enhancements to our Partners in Focus online web portal. This tool allows surgical facilities to access and manage their procedures in real time. It also automates the management process with regard to inventories of surgically implantable devices.

The latest updates, our fifth, include referral automation, greater reporting as well as faster and easier communication tools. All in all, we believe these changes will save surgeons’ time and enhance quality.

Each improvement we make is based on our ‘Voice of the Customer’ program that collects feedback from our partners in an effort to help all our customers continue to win in this challenging healthcare environment.

With the help of our customers and the great team at AMQ we are able to constantly improve and innovate. This means lower costs, better outcomes and a greater quality of life.

GRAPHIC: Medical Implants Trending Younger

Below is a fascinating graphic featured recently in the Star Tribune. From 2000-2010, the preponderance of pacemakers as well as artificial hips and knees have all increased across every age group. To me, this doesn’t say that people are living more dangerously with more chance of injury or heart disease. Rather, I see two messages here:  (1) medical science is making tremendous advancements, allowing patients to maintain active lifestyles and live more comfortably with implantable devices; and (2) with that astounding growth, it’s never been more important to have a comprehensive approach to managing implantable medical device surgeries so that patients, surgeons, surgical facilities and device manufacturers have clear visibility into device effectiveness and cost.  This graphic is both a window into innovation and changing times, as well as a call to action to get our arms around the fastest-growing segment of surgical costs.



To Understand the Tremendous Impact of Surgical Implants, a MUST Read: “The Insane and Exciting Future of the Bionic Body”




The Smithsonian published this month a fascinating article about the future of implants.  It’s a must read for anyone interested in how organs and limbs are being manufactured and how we are moving quite quickly toward replacing a large percentage of the human body with devices, which will be connected to the brain. It’s astounding. Here are just some of the excerpts that caught my attention:

“The past five years, in particular, have seen an explosion of innovation.”

“…the robot vividly showcases how much of our bodies can be replaced by circuits, plastic and metal … his team was able to rebuild more than 50 percent of the human body … bioethicists, theologians and others are contending with the question, How much of a human being can be replaced and still be considered human?”

“Improved software, longer-lasting batteries and smaller, more power-efficient microprocessors — the technologies driving the revolution in personal electronics — have ushered in a new era in bionics. In addition to prosthetic limbs, which are more versatile and user-friendly than ever before, researchers have developed functioning prototypes of artificial organs that can take the place of one’s spleen, pancreas or lungs. And an experimental implant that wires the brain to a computer holds the promise of giving quadriplegics control over artificial limbs. Such bionic marvels will increasingly find their way into our lives and our bodies. We have never been so replaceable.”

“Herr believes that insurance providers need to radically rethink their cost-benefit analyses. Although the latest bionic prosthetics are more expensive per unit than less-complex devices, he argues, they reduce health care payouts across the lifetime of the patient. ‘When leg amputees use low-tech prostheses, they develop joint conditions, knee arthritis, hip arthritis, and they’re on continual pain medication,’ says Herr. ‘They don’t walk that much because walking is difficult, and that drives cardiovascular disease and obesity.’”

Here’s how it boils down for me. For those needing replacement limbs and organs, these are unbelievably exciting developments, and the pace of innovation and change is remarkable. We should all welcome, embrace and encourage it. In addition to sparking imagination and inspiring hope, these breakthroughs also need to spark a dialogue about the best way to ensure that we can afford to deliver these medical miracles in a cost-effective, quality-conscious manner. It starts with paying more for truly innovative products that can demonstrate medical and clinical ROI, not just with the surgery but the continuum of care and patient needs including reducing adverse effects longer term. Too often we have seen in the implant space “me too” products introduced with tweaks here and there and marketed as “next generation.” Instead these products are not reflective of truly meaningful and measurable innovation and in many cases these are not forward steps but rather disastrous backward ones. (See the incredible number of recalls occurring with implants.)

Every health plan out there, or an employer offering health care, or governments covering large populations, have to be reading between the lines of this article and asking honest questions about how those who are so deserving of these devices are going to get them clinically and financially. It’s a simple one-word answer to a complex question: management. Even today’s implantable medical device sector is largely unmanaged, with compromised quality in some cases, high and escalating costs, a lack of data and visibility, poor communication and nearly none of the market-driven advantages to which the American consumers are accustomed.

We have to address today’s issues today, and that will prepare us for the fantastic challenges of the near future, as the Smithsonian highlighted. Let’s start by “managing,” but managing in a good way, so that patients, surgeons, surgical facilities and device manufacturers all win. I know it can be done because I’m doing it every day with my colleagues for some of this nation’s largest insurers. We’ve got problems to address today on this front that will only grow exponentially greater as we are able to alleviate the pain and suffering of our fellow human beings. Let’s take the blinders off and tackle this problem, together!

Aetna and ACO’s: Moving in the Right Direction

ImageCheck out this great interview on Aetna in the ACO arena. The real dollars are in managing high cost surgeries — Access MediQuip‘s wheelhouse.  If Aetna adds that in the mix they will be able to bridge the often sizable gap between cost, quality and safety in implantable device surgeries pre, intra and post surgery.  Our bundling solution is ready-made for emerging accountable care organizations, and is good for patients, surgeons, facilities and health plans.