Are you considering spinal surgery?

Do you know if your doctor is part of a Physician Owned Distributorship, or POD?

If your reaction is – "Wait…what?" – you’re not alone.

"It's virtually impossible for the patient to know" if a doctor is part of a POD, KPCC investigative producer Karen Foshay told me. Her two-part series on PODS, Selling the Spine, aired this week.

But a patient should be armed with this knowledge before undergoing intensive surgery, she said. Here's what consumers should know about PODs:

What's a POD?

It's a business model where the doctor is an investor in – and distributor of – the devices or hardware he or she may put into patients. Multiple doctors can have a financial interest in one POD.

Check out PODS 101 for more background information. 

What's the concern with PODs?

PODs provide a financial incentive for the physician investors to use their devices in the surgeries they perform. Here's the real concern: This financial incentive could encourage doctors to do unnecessary surgeries - or overly complex surgeries - because the more parts going into a patient, the more money for the POD. 

That's the situation Azike Ntephe claims he found himself in. A doctor - Pomona surgeon Ali Mesiwala - implanted a cage and dozens of nuts, bolts and screws in his spine in 2009. He said the surgery didn't work.

Foshay reports:

Ntephe claims in his lawsuit that Mesiwala never told him that the doctor had a financial interest in the hardware he used in his surgery. Ntephe said he only learned about it after the parts were removed. The suit is pending.

"I didn't know anything about it," said Ntephe, adding that he would have refused the surgery "if I had known that he had a financial interest."

Yikes! So if I’m considering spinal surgery what – exactly – should I do?

Information about PODs, who's involved, and who benefits, isn't easily available through any database or association, Foshay told me. The companies themselves, she said, are private businesses and not required to disclose their investors.

• So, she said, patients have little choice but to ask their doctors directly: "Are you part of a POD? Are you making money off the device you're going to implant in me?"

"I know it may be uncomfortable, but that's really what you have to ask," Foshay said.

• Patients could also ask the hospital if it purchases devices from PODs – but good luck. Foshay said she called 30 Los Angeles area hospitals, and only five had a policy on them.

"Most didn't even know what we were talking about," she said.

• Patients should also Google their potential surgeons, Foshay said, or look up their doctors in this database of Medicare data, built by CBS.

She added a word of caution: If a doctor does a ton of spinal fusions or surgeries, it might be a red flag, but certainly not a smoking gun. There could be other explanations, like the doctor is an academic or the only one in the area doing that surgery.

• She also recommended getting a second, and third, opinion, before undergoing a big, risky surgery.

Really? I have to do all of that?

Yes – for now.

But in September, Foshay said, it's expected that much of this data will go online, through the Centers for Medicare & Medicaid Services. Using this tool, patients will have more information about which doctors are investing in PODs, and who's paying them.

Have you had an experience with a doctor involved with a POD? Do you have more questions about PODs? Tell us in the comments section below, or e-mail us at Impatient@scpr.org. Your story could inform future reporting.