Four spine surgeons discuss the regulations that they believe stand in the way of patient care.
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: What regulatory factors currently pose the biggest threats to effective spine care?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Nov. 29, at 5 p.m. CST.
Question: What regulatory factors currently pose the biggest threats to effective spine care?
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: MACRA/MIPS remains a troublesome piece of legislation. From its piecemeal, clunky, poorly supported rollout to its uneven and herky-jerky implementation it has been a black hole of regulation. It still escapes me, and I think most of the medical community, how it is supposed to help doctors be better. I think the only success will be in causing doctors to drop Medicare and drive them more to employment.
Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): I believe the continued adoption of nontransparent treatment guidelines by insurance companies is an increasing problem. Many of the guidelines adopted by insurers bear no resemblance to the guidelines established by the spine surgical specialty societies. There are often arbitrary designations of procedures as "experimental" even after years of successful use, which eliminates access to meaningful treatment options for some patients.
Many of these individuals are then cast into chronic pain management situations, which lead to pharmaceutical usage. I believe this is a contributor to the opioid epidemic we hear about almost daily. When meaningful treatment options are denied and access to curative options is curtailed, while the patient's pain remains real and present, many become desperate and turn to the few options they have remaining. Emergency room visits and opioids become a reality, and when the opioids are cut off, some turn to street drugs to help with the pain and, what is at times, an addiction. I certainly see these types of patients in my practice.
If the patient is ultimately able to obtain treatment after lengthy appeals, we are still left with the effects of long-term narcotic usage which makes the postoperative convalescent course more challenging for both the patient and the surgeon. Anyone telling you rationing of care as a means of cost containment does not exist is either not seeing a substantial volume of patients or is looking the other way.
Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): The increasing hurdles insurance carriers are placing to "approving" spine care for patients. More often, surgeries are being denied for patients in need. The burden is then placed on the treating physician to spend time and energy appealing decisions often made by a physician with no experience in caring for spine pathology. Without any consequence, carriers will continue this trend frustrating spine surgeons, and more importantly, frustrating patients.
Scott Blumenthal, MD. Spine Surgeon at Texas Back Institute (Plano): The fact that each carrier uses their own criteria for access to diagnostics and treatments, which is difficult for the practitioner to keep up with and totally nontransparent to the patient.