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28 December 2010

Limit set on popular procedure on spines

Blue Cross is under fire for seeking to curb use of expensive spinal fusions.

By Alan M. Wolf

More Information

  • 3,593: number of spinal fusion surgeries Blue Cross and Blue Shield of North Carolina covered last year, up 22 percent from 2007.
    $105 million: amount the insurer paid in claims for the procedures last year, up 44 percent from 2007.
    Nine: number of medical associations that signed a Dec. 15 letter to Blue Cross, urging changes to its new policies, which take effect Jan. 1.
    3.7 million: Blue Cross members statewide.

The state's largest health insurer is coming under fire from surgeons across the country for implementing tougher restrictions on an increasingly common type of spinal surgery.
Blue Cross and Blue Shield of North Carolina's new rules, which take effect Jan. 1, are designed to reduce overuse of spinal-fusion surgery, a costly and controversial procedure to ease patients' lower back pain . The Chapel Hill-based insurer says it wants to ensure the surgeries are approved based on the latest medical evidence.

"We are not going to stop coverage, but we do want to make sure the ones being done are appropriate," said Dr. Don Bradley, Blue Cross' chief medical officer. "In some cases, we're seeing technology being used when more conservative measures might be more appropriate."
But some spine surgeons worry that the restrictions will limit care for thousands of patients and could set a new coverage standard among other insurers.

A coalition of surgeons representing nine medical associations, including the American Association of Neurological Surgeons and the North American Spine Society, wrote to Blue Cross this month, urging the company to reconsider.

As Spinal Fusion Volume Grows, So Do Profits for Surgeons & Device Makers

Report outlines controversies over device-heavy spine procedures and surgeon-manufacturer relationships.

Are financial relationships with medical device companies and profitable reimbursement margins inducing spine surgeons to perform more fusions than necessary? A recent report in the Wall Street Journal explores several controversies associated with the growing market for these device-heavy spine surgeries.
Medicare paid $343 million for spinal fusion procedures in 1997, compared to $2.24 billion in 2008 — a nearly 400% increase, according to the Journal's analysis of Medicare data.
Within the medical community, doctors are divided between more conservative spine surgeons who believe fusion should be used sparingly to treat a small number of conditions, such as scoliosis, and surgeons who advocate using fusion to relieve chronic back pain or to treat degenerative disk disease, one of the most hotly debated uses of the procedure. 

Blue Cross and Blue Shield of North Carolina announced earlier this year that it would stop paying for spinal fusions performed to treat aging disks beginning on Jan. 1, 2011. Nine medical associations, including the American Association of Orthopaedic Surgeons, recently sent a letter to the insurer to express concerns over the new policy and advocate for less restrictive language.
One thing is certain: The increase in spinal fusions has been a boon for the companies that make and sell the hardware and implants used in spinal fusion surgery, which can cost tens of thousands of dollars for a single procedure. 

Meanwhile, companies like Medtronic, the largest manufacturer of spinal implants, pay surgeons millions of dollars in royalties for their help in developing new technologies. Medtronic and the surgeons who collaborate with the company say the payments are a legitimate way for surgeons to give input on new devices and do not create a conflict of interest. Critics, including some members of Congress, argue that they are essentially kickbacks designed to boost medical device sales. 

In response to this criticism, Medtronic began disclosing its payments to surgeons publicly on its website in June, and many doctors who partner with device makers say they disclose these relationships to their patients. A provision in the Affordable Care Act requires all companies to disclose such payments made to physicians by 2013.
Read the full WSJ report here.