Spine surgeons say healthcare policy needs to address two persisting obstacles to patient care: administrative barriers and insurance restrictions.
Changes in the system would benefit the speed of patient treatment and bring welcome transparency to the process.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
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Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, March 10.
Editor’s note: Responses were lightly edited for clarity.
Question: What policy change would most improve access to appropriate spine care in your market?
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Reform of utilization management to genuinely support appropriate care rather than creating administrative barriers. The current system was designed to prevent overtreatment, but it often delays or denies proven procedures while creating enormous burden for physicians trying to do right by patients. Most surgeons want evidence-based utilization review — we welcome oversight that improves care — but current processes add cost without demonstrable benefit.
I’d also advocate for mandated coverage of comprehensive conservative care: coordinated multidisciplinary programs with adequate resources, not just six PT visits that check a box. When insurers cover fusion but won’t pay for intensive functional restoration, they’re forcing patients and physicians into treatment pathways nobody thinks are optimal.
Finally, transparent outcome reporting would empower patients to make informed decisions and would reward surgeons committed to excellence. Most spine surgeons I know would welcome this transparency because we went into medicine to help people and believe our outcomes reflect that commitment.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Realistically, the most applicable and pertinent of policy changes from a healthcare system standpoint would comprise stronger adherence in establishing patient continuums from emergency rooms scenarios/visits involving other spinal consultants. Because of predisposed and personally selective insurance preferences, patient assignment and subsequent follow-ups are mired with refusal of care and further delays in diagnosis and treatment. Interhospital transfers based on insurance or remote ‘trauma’ designations have become a large part of this issue both locally and regionally.
