Reasons to advocate
1. Stricter guidelines for spine fusion coverage. Led by the Blue Cross Blue Shield of North Carolina, which refuses to cover spinal fusions for patients with degenerative disc disease, payors are increasingly adopting stricter guidelines for which spinal fusions will be covered. Many spine surgeons, including Dr. Subach, see this as problematic because many of the patients they do select for surgery have found the procedure beneficial. "If I were practicing in North Carolina, 85 percent of my patients would not be able to have these procedures because the insurance companies are stating that there isn't sufficient evidence to show [spinal fusions] work," he says. "It's about reduced access to healthcare for spinal patients. These patients have a poor quality of life and the companies are saying they can’t have the surgery their surgeon recommends."
NC BCBS's coverage policy took effect Jan.1, and surgeons should expect other states to quickly follow suit. "Now that North Carolina has laid down the gauntlet, we are hearing from surgeons across the country that patients aren't able to get spinal healthcare in their states," he says. "There are also insurance companies saying the use of artificial discs is investigational, even though they have been approved by the FDA. We have to fight tooth and nail to perform artificial disc surgeries on our patients."
2. Government calling for evidence-based medicine. An increased focus on evidence-based medicine means that payors want to see randomized, prospective studies showing that spinal fusions can give patients better outcomes than the patients who don't undergo surgery. There was a study published in the New England Journal of Medicine showing that vertebroplasty didn't produce better outcomes than a "sham" procedure. However, other studies, such as Vertos II, found that vertebroplasty can have benefits for appropriately selected patients. Another study, written by Joseph Weisstroffer, MD, found that of the professional football players who underwent microdiscectomies for disc herniations, 80 percent were able to return to play, 50 percent of those went back to their starting positions.
However, some critics of Dr. Weisstroffer's study say that because it wasn't a randomized, prospective study, the findings have little value. Dr. Schuler and Dr. Subach work with professional athletes from the Washington Redskins and they know how important it is to return professional football players to the field in the most efficient manner. "Basically, we're saying that in order to prove whether or not I should do surgery on the athletes, I need to randomize them into a group that does or doesn't get surgery," says Dr. Subach. "This is a decision that makes a huge impact on their career. How do you tell players that they shouldn't have these surgeries that get them back onto the field 80 percent of the time?"
Spine advocacy methodology
3. Share patient success stories through a video platform. Dr. Subach and his team have put together dynamic videos featuring patients who underwent successful spinal interventions. The patients discuss their treatment process and how the procedure worked for them. The videos are uploaded on the internet and distributed on the practice website and through social media outlets. "We're trying to permeate the social networking sites to show our videos and show how spinal healthcare truly works," says Dr. Subach. "The idea is to amplify the impact by showing the patients' faces as they illustrate how access to interventions can be life changing and life altering."
4. Host community events. The Spinal Research Foundation is also showing support for and building awareness of spine patient advocacy through community events, such as hosting a 5k Race and 1 Mile Fun Run/Walk. The organizers encourage patients, local businesses, and members of the community to show support for spinal health. Surgeons honor their patients who have undergone surgery with yellow jerseys, recognizing them as "Spinal Champions." "These patients are saying 'Look, I couldn't have done this if it weren't for the healthcare I received'," says Dr. Subach. The Washington, D.C., race site is in its fourth year and has been able to attract over 500 participants each year. The organization is currently planning four of these events around the country and hopes to expand to 22 events in the coming years. They are also working to promote a "Spine Healthcare Week" focused on education about spinal healthcare.
Check out the "We've Got Your Back" Event online.
5. Educate early. Dr. Schuler and Dr. Subach have teamed up with elementary schools in their community and given presentations to the children about maintaining a healthy spine. They bring a model of the spine to demonstrate how it works and then teach the children about the proper lifting techniques and how to swing a bat or kick a ball without putting stress on the spine. "We are trying to teach these kids how to prevent future injuries," says Dr. Subach. Spreading awareness around the community builds support and trust for spinal healthcare."We need to maintain access to healthcare for all patients."
Learn more about The Virginia Spine Institute or The Spinal Research Foundation.
Read other coverage on spine surgery advocacy:
- Spine Surgeon Advocacy Efforts: Q&A With NASS Advocacy Committee Chair Dr. Raj Rao
- NASS Advocacy: 3 Areas of National Focus