Wednesday, October 30, 2013

Oh, my aching back

I'll preface this by saying that I am not trying to make light of any back issues.  I've pulled a muscle or tweaked a nerve before and it is a very difficult issue to deal with.

However, with close to 33% of all disability claims being for back and other musculosketal issues it's worth reviewing.  Interesting the percentage of claims relating to back/musculosketal has jumped from just 8% of claims in 1961 (50 years ago) when arguably the bulk of the workforce was engaged in more physically demanding jobs.

However, the real subject today is the push for unnecessary procedures and what this means for our economy as we attempt to have a serious discussion about the future of healthcare in this country.  Yesterday, the Washington post published an article on the rise in spinal fusion surgeries and the push by some doctors to encourage patients to pursue this course of treatment even when it is not in their best interest.

"By some measures, Federico C. Vinas was a star surgeon. He performed three or four surgeries on a typical weekday at the Daytona Beach, Fla., hospital that employed him, and a review showed him to be nearly five times as busy as other neurosurgeons. The hospital paid him hundreds of thousands in incentive pay. In all, he earned as much as $1.9 million a year.

Yet given his productivity, some hospital auditors wondered: Was all of the surgery really necessary?

To answer that question, the hospital in early 2010 paid for an independent review of cases in which Vinas and two other neurosurgeons had performed a common procedure known as a spinal fusion. 
The review was conducted by board-certified neurosurgeons working for AllMed, a company accredited to audit health-care businesses.

Of 10 spinal fusions by Vinas that were selected, nine were deemed not medically necessary, according to a summary of the report.

More than 465,000 spinal fusions were performed in the United States in 2011, according to government data, and some experts say that a portion of them — perhaps as many as half — were performed without good reason."

There is a ton of good info in the article :
*  a 600% increase in the number of spinal fusion surgeries in the US in the last 17 years.
* treatment rates in the US are 3 times higher than Australia or the UK
* Sales of spinal fusion medical equipment exceed $5 bil/yr - twice the rest of the world COMBINED!

These are some of the issues playing out in the healthcare/insurance landscape today:

* Insurers are scrutinizing every treatment (even those medically necessary) because they have had to pay out on unnecessary treatments.

* Insurance companies "deal with the cost" so consumers and doctors (the ultimate parties in the transaction) never discuss cost.  The next time your doctor recommends a test or something ask what it costs and you'll more than likely be greeted with a blank stare.

I wish we could have a rational conversation on healthcare but as the antics in Washington have shown rational + DC is not an equation that works.


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