Spine surgeons face several huge challenges today; what are the biggest challenges?
Frank M. Phillips, MD, Co-Founder of the Minimally Invasive Spine Institute at Rush, says, "What we have witnessed over the past few years is a systematic effort to marginalize physicians and reduce their decision-making abilities in an attempt to have others dictate and thereby ration health care under the guise of "reigning in costs." Spine surgery is discretionary with large up-front costs making us an easy target. In order to accomplish these goals, spine surgeons have been portrayed as largely providing non-evidence based care to "fatten their wallets" without regard for patients well being. Physicians have inaccurately been singled out as the major drivers of costs of healthcare. As a consequence of this insidious attack on spine surgery, spinal surgical decision-making is increasingly dictated by bottom-line driven insurance companies using non-transparent, non-validated guidelines as an opportunity to deny spinal care.
"Over the past decade, a wealth of quality spinal data has been published supporting good clinical outcomes and cost-effectiveness for spinal fusion surgery for a host of diagnoses. However, with the shift of decision-making power away from spine surgeons, emboldened payers selectively ignore or cherry pick studies or data to suite their ultimate goal — reducing costs and driving profits.
"This message was brought home when on a recent call a physician reviewer (a retired obstetrician) informed me 'his company had a policy of a blanket denial of all lumbar fusions.' These types of intrusions into the doctor-patient relationship and decision-making are our greatest challenge to providing our patients with the best evidence-based care. Addressing this will likely require a combination of continuing to gather validated evidence, a more active and coordinated effort by our spinal organizations and a patient and public advocacy push."
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