Feb 15, 2015

Spine surgery is a continually evolving specialty.  Some recent changes have been positive, while others can be viewed negatively. For example, an important positive change is the trend toward less invasive surgery, which results in faster recovery times, allowing patients to return to daily activities more quickly. As we gather data and experience, we can more precisely define indications for surgery as well as standardization of treatments.  New technologies like artificial disc replacements for neck disorders, also allow patients to regain quality of life with less down time.

On the other hand, some changes make it more difficult for patients by making it more complicated for physicians to recommend and deliver treatment to their patients.  For example, now it takes much more time to receive authorization for surgical procedures. In the past, if the surgeon and the patient decided the next step is surgical treatment of their spinal problem, the physician would submit to the insurance carrier the operation request. Typically, unless there were exceptional circumstances, the procedure would be authorized.

Now office staff spend a disproportionate amount of time trying to get an operation authorized.  Insurance companies require more details about the procedure. This might include the approach being used, or whether metal rods and screws, cages, or bone products will be used.  Diagnosis codes have to match the procedure requested.  Procedures that were routinely accepted in the past now require a physician-to-physician discussion before procedures can be approved.  Sometimes the insurance company fails to notify the patient or the surgeon about the procedures they will cover. Other times, decisions are based on the insurance company’s selective use of scientific date to support its position.

The reality is that when it comes to surgical treatment of spinal disorders, physicians and patients have less control in the care they deliver and receive. Longer approval times for surgical procedures can result in delay in care, sometimes for weeks or months.  This means that patients face more time off from work, and their employers get less productivity.

Studies tell us that once a spine problem hits the surgical threshold, it will not improve. Delay ultimately results in higher healthcare costs and more lost productivity.  The SPORT trials in the United States confirmed that timely surgical intervention is better than delaying care. In many cases, it is also less expensive in the long run.