Which Spine Procedures Are Difficult to Receive Reimbursement For?


Six spine surgeons discuss the reimbursement environment for spine surgery. 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. We invite all spine surgeon and specialist responses. Next week's question is: Why have you chosen to or not to become employed by a hospital?

Please send responses to Laura Miller at laura@beckershealthcare.com by Tuesday, Feb. 7 at 5pm CST.

Q: Are there any spine procedures you are having a hard time receiving reimbursement for?

Dennis Crandall, MD (Medical Director, Sonoran Spine Center, Mesa, Ariz.):
The Milliman Care Guidelines and their unwavering adherence by insurance reviewers have led to declines to our office for fusions for recurrent disc herniations with back pain, fusion for degenerative disc disease, fusion for post-laminectomy back pain with degeneration and spondylosis, fusion for degenerative lumbar scoliosis with rotational listhesis, fusion for adolescent idiopathic scoliosis (45 degree curve), and fusions for special needs children with scoliosis (Physiatrist reviewer: not enough PT). Also, since the NASS leadership-supported Spine Journal editors came out strongly against BMP, we are having a harder time getting it approved, regardless of the indication.

J. Brian Gill, MD (Spine Surgeon, Nebraska Spine Center, Omaha): Disc replacement procedures are still difficult to get approval for to the point where it is not worth the effort to petition insurance companies to approve the procedure.

Michael Gleiber, MD (Founder, Michael A. Gleiber, MD, PA, Jupiter, Fla.):
Recently we've had some trouble being reimbursed on osteobiologics, including BMP, as well as spinal fusions.

Purnendu Gupta, MD (Medical Director—Chicago Spine Center at Weiss Memorial Hospital, Associate Professor of Surgery in Orthopedics and Rehabilitation—University of Chicago)
: Many times when we do major revision operations, the reimbursement doesn't reflect that. On the hospital side, there is aloss of revenue because it was a more expensive procedure and our current policy does not reimburse the hospital high enough either. This ultimately may cause limitations in our ability to take care of patients with complicated problems.

Paul Slosar, MD (President, SpineCare Medical Group, San Francisco Spine Institute):
Spinal fusions continue to be challenging.

Brian Subach, MD (Director of Research and Spine Surgeon, Virginia Spine Institute, Reston): Cervical and lumbar disc arthroplasty are universally denied since they are considered "experimental" by private insurers despite excellent, published, level I evidence establishing efficacy. We are having increasing difficulty getting approval for procedures treating degenerative disc disease.

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