On April 24, CBS This Morning aired a report titled "Tapping into Controversial Back Surgeries," examining fusion rates around the United States.
The report depended on the newly-released CMS physician payment database with information about the number of spinal fusions individual physicians billed to Medicare from 2011 to 2012 under common degenerative conditions for low back pain. Here are five things to know about the report:
1. In addition to filing the report, CBS made the data available online in a downloadable spreadsheet. The spreadsheet includes individual information for more than 5,900 surgeons about:
• Number of patients seen from 2011 to 2012 (average: 651)
• Number of vertebral fusions performed (average: 4)
• Percent of patients seen that had fusion (average: 7)
• Total fusions (average: 46)
The spreadsheet is searchable by the physician's name and city. The CBS report quotes Sohail Mizra, MD, chair of orthopedics at Dartmouth-Hitchcock Medical Center, suggesting patients seeing specialists with a greater percentage of patients undergoing fusions ask why their number is so high.
2. The report notes numbers gathered from the database do not include whether the surgery was appropriate, and the North American Spine Society sent CBS a letter warning about the "hazards of commenting on a particular case without viewing the complete medical record." According to the CBS report, a small number of surgeons perform spinal fusions more frequently than others — exceeding 460 procedures over two years when the national average was 46.
Daniel Resnick, MD, vice chair of neurosurgery at the University of Wisconsin School of Medicine and president of the Congress of Neurosurgeons was quoted in the report as saying the statistics were concerning and that some surgeons may be "operating outside of the generally agreed upon (based on common practice and literature supported guidelines) parameters."
3. Spinal fusions in United States hospitals increased 70 percent from 2001 to 2011 according to data from the CBS report, with growth attributed to several factors: better technology, better-trained surgeons focusing on spine, an increased aging population and more demand for mobility, according to the report. A previous study published in May 2012 titled "Spinal Fusions in the United States: Analysis of Trends From 1998 to 2008" used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and found spinal fusions increased 137 percent over that 10 year period. Costs jumped from $4.3 million in 1998 to $33.9 billion in 2008.
"In today's more health conscious society there's often not much difference between a healthy 72-year-old compared to someone in their mid-60s. Consequently, you will see more and more spinal procedures performed on Medicare beneficiaries," said Barry Zeman, former hospital CEO and Head of C-Level consulting services for Specialty Healthcare Advisers, the hospital and surgeon consulting division of Musculoskeletal Clinical Regulatory Advisers, LLC (MCRA), in a Becker's Spine Review report earlier this year. This is evidently why spinal fusion procedures have received so much recent attention from CMS in recent years. Not only have the amounts of Medicare beneficiaries receiving spinal fusion procedures increased, the costs of these (often elective procedures) are among the highest around.
A MarketsandMarkets report on the spine surgery market forecasts the global spine surgery devices market will be worth $14.8 billion by 2017. The market reached $11.5 billion in 2012 and estimated annual growth rate is 5.1 percent over the next five years.
4. The report found that 5 percent of surgeons did around 40 percent of the fusions on four or more vertebrae. On average, surgeons perform vertebrae fusion on four or more levels on less than seven patients annually, amounting to around 1 percent of the surgeon's total patients. Surgeons on average perform total fusions on four or more vertebrae levels for less than seven patients per year.
5. Several professional societies have published guidelines on spinal fusion. Just last week, the North American Spine Society released the first 13 coverage policy recommendations, with one on spinal fusion. The recommendations are based on published comparative effectiveness studies published in the literature and the panel developing these guidelines included both operative and non-operative specialists.
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