Insurer targeting low hanging fruit — spine surgeries

HealthPartners in Minnesota is planning to begin next month requiring surgeons to advise patients of less expensive alternatives to spine surgery for treatment of their low back pain. 

At $25,000 per surgery for the roughly 600 procedures it covered in 2007, HealthPartners paid $15 million for procedures that, it believes, in some cases were not not justified by the evidence.

Spine surgery is not yet the target of widespread cost-cutting initiatives by insurers, but with a growing patient population combining with minimally invasive technologies that expand the number of patients amenable to the procedure to further burden insurers, it is clear that HealthPartners’ moves will be replicated by other payers.

What will come from this will be a series of actions and reactions:

  1. the inevitable backlash by physicians against patient care being administered by CPAs.
  2. marketing campaigns by devices companies indicating high clinical efficacy of their approaches
  3. marketing campaigns by these or other device compaies indicating the lowered long term cost of their approaches
  4. responses like those noted by Dr. Kevin Pho (of kevinmd.com/blog reknown) who highlights the method by the UK’s National Health Service to get physicians to buy into reform, suggesting a similar possibility for the U.S.

These dynamics (and others spun off of them) will be the subject of debate in the U.S. over the next few years as the economy, the latent need for healthcare reform and a new administration in the White House will clearly propel reform from the abstract idea spine surgeons have previously understood to a very tangible impact on their practices and their patients’ options.


See also the MedMarket DIligence Report #M510 on Worldwide Spine Surgery.

 

2 thoughts on “Insurer targeting low hanging fruit — spine surgeries”

  1. Degenerative disc disease is not prevented by excercise, nor is scoliosis and many other conditions for which spine surgery is used. Your point is certainly well taken for preventive approaches, but it's just not as relevant for spine surgery.

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