Since that first case, multiple total disc replacement devices have hit the market, and studies demonstrated the safety and efficacy of the procedure for lumbar and cervical spine. But the procedure has also faced obstacles related to payer coverage.
Dr. Blumenthal of Texas Back Institute in Plano joined the “Becker’s Healthcare Podcast” to discuss the state of total disc replacement and his frustrations with payer systems.
Note: This is an edited excerpt. Listen to the full conversation here.
Question: As a leader in total disc replacement, what’s your perspective on how the procedure has evolved in the U.S.?
Dr. Scott Blumenthal: I was seeing patients in my office, and [disc replacement] patient No. 2 in the U.S. from 25 years ago came back for follow-up, and now we’ve got X-rays that were all good. Our technique continues to improve. Starting off, talking lumbar, low back, because that’s what the 25 year anniversary is. Lumbar disc replacement is one of the most studied operations, not only in spine, but in medicine. There are more than 1,000 peer review publications in the time that this technology has been out, as well as some very, very high quality data, high quality research that almost no other devices, except maybe for cervical disc replacement have gone through. It’s changed my practice. It allowed people to have their pain treated and return to a more normal function quicker than the previous standard, which was fusion surgery. So it’s been a real boon for patients.
Q: Payer coverage has been a challenge for disc replacement’s expansion in the U.S. What can spine surgeons and patients expect in the next five years?
SB: That may be my No. 1 cause at this point because coverage has been a problem. Even more so, not just coverage, but it’s the restrictions that the insurance industry places upon us using an FDA-approved device. Never before in my career has there been so much scrutiny and oversight. If you don’t check one box appropriately, or the patient just doesn’t fit the perfect FDA criteria, they’ll turn down the procedure. And very little is left to the discretion of a competent surgeon. We’ve seen a lot written about this, but the whole peer-to-peer process is just a joke. Oftentimes you have physicians that are not practicing. They’re not in your same specialty, they’re just reading off the list, and the whole “peer-to-peer” is a misnomer.
You asked what it’s going to be like in the next five years or so, and I’m a bit discouraged because I would have thought with the recent scrutiny placed upon healthcare insurers denying coverage, particularly with the murder of the United CEO, that there would be more light placed on the process that makes people so frustrated that someone would do such a terrible thing. But having said that, the insurers do terrible things to the patients when they’re in their worst place, which is needing care. It’s gotten taken out of the realm of the judgment of competent and caring physicians that are trying to help people, and not every patient fits into a little box or a little checklist.
