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Dr. Frank Phillips: No. 1 concern for spine? Insurance companies dictating care Featured

Written by  Laura Dyrda | Tuesday, 17 October 2017 14:50
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Frank Phillips, MD, co-founder of the Minimally Invasive Spine Institute at Rush in Chicago, discusses his biggest concern for spine surgeons today.

Question: What are your top concerns as a spine surgeon for the future?

 

Dr. Frank Phillips: My biggest concern is insurance companies directly dictating patient care. Over the past few years we have seen insurance companies deny patient care under the guise of surgeries being considered "experimental or investigational" despite clinical evidence to the contrary. Becoming further emboldened after seeing little cohesive push back, insurance companies are now dictating details of procedures in terms of which specific implants may be used.

 

I recently had a phone call for a "peer-to-peer" review (the "peer" being a non-surgeon) who informed me that the specific generic basic PEEK cage I was using for a TLIF, was "not on the approved list." This would necessitate me switching an identical cage from another manufacturer [that] I am unfamiliar with, at greater cost to the hospital and payer. This level of intrusion into the care we provide, extends beyond value/cost-effectiveness. In effect this represents an abrogation of our patient care to administrators and bureaucrats to an unprecedented level.

 

I look anxiously to our spine surgeon-focused organizations that are funded by surgeons dues, to aggressively represent their constituents.

 

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5 key findings on cost, length of stay for Medicare beneficiaries undergoing cervical spinal fusion

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