Future of device.....tougher FDA approval process to get new products to the market. Once they are "FDA" approved, then there will be even tougher payer requirements, which will lead to lower reimbursed amounts to hospitals and physicians, or no coverage at all.
You see this already happening, and it will get worse. Device companies are already starting to rethink their R&D process (as they should).
The "build it and they will come" model won't work. If you can't prove value to EVERYONE in the health system (physicians, hospitals, patients, PAYERS, GOVERNMENT), then it will be a tough battle for the product. Surgeons won't be able to demand the use of a product just because they want to.
And many physicians practices are becoming part of hospital systems (owned by hospitals), so they are more vested in the cost of devices and the "I don't care what it cost, I want to use it" attitude will disappear.
Device companies will figure it out, but it will take some time. I'm sure there will be a lot of consolidation of companies.
If companies can't prove the value of the device, then prices will surely fall (what Obama wants), which isn't good for a sales rep (paid on % comm), and comp plans will changes to generate more profit for the company (if they can't charge a premium price, then they will take some cash out of reps side to make up for it).
Just think about it, before Obamacare, did you company ever come out with a comp plan that paid you better than the year before?? Probably not, and that was before they had healthcare reform as an execuse to cut commissions. Now that they can say they need to cut commission because of Obama, it might get ugly pretty fast.