Cigna Reports 15% of Spinal Fusion Customers Undergo 2nd Surgery: 5 Key Points

Written by Laura Dyrda | June 23, 2014 | Print  |

 

In 2011, Cigna examined spinal fusion patients and found 87 percent of customers who had fusions were still experiencing pain and undergoing additional therapies or drugs two years later, according to a report from the Tampa Bay Times.

 

 

The article questioned whether other insurers and Medicare would follow suit. Here are five findings from the report:

 

1. Almost 15 percent of patients who underwent spinal fusions had more surgery. A study of Medicare claims from 2005 to 2009 shows readmission rates for spinal stenosis decompression were 8 percent to 10 percent with and without fusion, according to a Medscape report.

 

2. The total cost of post-surgery claims was $11 million. An Agency for Healthcare Research and Quality statistical brief shows spinal fusions are one of the costliest procedures in the United States. In 2011, spinal fusions cost an average of $12.8 million, with the average cost per hospital stay at $27,600. There were around 465,000 hospital stays for spinal fusion in 2011.

 

3. Cigna tightened coverage after seeing the results of the report. Several other insurance companies have changed their coverage protocol over the past few years, adding stricter indications for spinal fusion. Earlier this month, an article in a local Kansas newspaper reported that the Blue Cross and Blue Shield of Kansas made spinal fusion coverage changes in 2013 and one year later patients feel their access to care is limited even after multiple in-network surgeons deem the procedure medically necessary.

 

4. Medicare doesn't have upfront approval for spinal fusions, but can recover money for surgery later deemed unnecessary. A report shows Medicare improperly spent $120 million on lumbar fusions in 2012. The tighter indications for spinal fusion and a challenging reimbursement market led Research and Markets to predict the United States' share of the spinal fusion market will shrink from 71 percent in 2013 to 63 percent in 2020. At the same time, developing markets are expected have larger growth; China will gain 5 percent market share, making their entire market share 10 percent in 2020.

 

5. A Dartmouth Atlas Health Care report found where patients get surgery depends more on where they live and how surgeons practice medicine there than overall protocol for medical necessity. The report examines Medicare enrollees in 2002 and 2004, showing surgical rates varied by a factor of more than 20 across the country. Spinal fusion rates were highest in these areas:

 

•    Idaho Falls, Idaho
•    Missoula, Montana
•    Mason City, Iowa
•    Bradenton, Florida
•    Casper, Wyoming

 

The rates were lowest in these areas:

 

•    Bangor, Maine
•    Covington, Kentucky
•    Terre Haute, Indiana
•    Grand Forks, North Dakota
•    Newark, New Jersey

 

The report also found that in 80 hospital referral regions, lumbar fusion rates were around 30 percent higher than the United States average. However, in 98 hospital referral ranges, rates were more than 25 percent lower than the national average.

 

More Articles on Spine Surgery:
Deconstructing the Cost of Spine Care: Where Dollars Really Go
Securing a Stable Future for Spine Surgeons: What Stands in the Way
8 Core Concepts for Cutting-edge Comprehensive Spine Practices Today

 

© Copyright ASC COMMUNICATIONS 2019. Interested in LINKING to or REPRINTING this content? View our policies here.

Top 40 Articles from the Past 6 Months