Spinal procedures are evolving to become less invasive and more effective with new technology enhancements. But not all health plans have caught up.
John Prunskis, MD, medical director of DxTx Pain and Spine, said during a panel at the Becker's 21st Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference that spinal cord stimulation and sacroiliac joint fusions in particular have made big improvements in recent years. Medicare and workers compensation cases have seen positive outcomes with new technologies and studies published in professional journals support their use.
"Technological advances are huge and now it's a matter of getting insurance companies to understand that and agree to pay for it," said Dr. Prunskis.
That's easier said than done. Some companies are willing to pay for new, less invasive technologies while others create significant roadblocks. Insurance companies are all different, and large companies have policies that vary by state. Even Medicare is regional, said Dr. Prunskis.
"Our greatest successes in contract negotiation have been in demonstrating data that insurance companies perhaps have not looked at in the way we look at it," he said. "Show them better outcomes and cost savings, and lower opioid usage, in their patients that have gone through the algorithmic-based data-driven protocols."
Spine surgeons and specialists have spent years advocating for minimally invasive technologies and designing studies to prove efficacy. They see benefits for their patients in quality outcomes and lower costs, but still some insurance companies balk at coverage.
"One thing that's somewhat disconcerting is there's one new minimally invasive technology that has Level 1 evidence; that's the highest level of evidence you can possibly get in research and one insurance company has said, unfortunately, in order for us to add this code, they want to renegotiate the entire contract," said Dr. Prunskis. "As a physician, that's such a painful thing to hear when you know that there's a service you can provide to your patients with Level 1 evidence, and the insurance company is leveraging your entire contract to add a procedure."
Dr. Prunskis said he has to tell patients to see another physician outside of the practice for certain procedures because the insurance company won't pay for them.