Spine Patient Society Plays a Pivotal Role in Recent Uproar Regarding the New North Carolina BC/BS Policy on Spinal Fusion Coverage

[Justin]

Hello SPS Members,

I hope this message finds you well. The Spine Patient Society was instrumental** in providing the International Society for the Advancement of Spine Surgery (formerly the Spine Arthroplasty Society) with documentation on 10/31/10 regarding the North Carolina Blue Cross/Blue Shield Insurance (BC/BS NC) company's new policy (effective January 1, 2011) on spinal fusion coverage. Below explains what transpired after the Spine Patient Society was contacted by the International Society for the Advancement of Spine Surgery. I do hope our efforts will help spine surgeons across the country as well as the professional societies that represent them. Our Society wishes them the very best in this fight.

**Edit: see the Spine Patient Society's specific role posted in Post #5 in this thread.
____________________________________

Here's the email that was sent on November 17th to International Society for the Advancement of Spine Surgery Members:

Alert: Changes to Spine Fusion Insurance Reimbursement Policy

The SAS is alerting our membership regarding recent changes to a US insurance reimbursement policy covering spine fusion procedures. The revised policy may affect all SAS members, including international members, in the future. As past SAS President Chun-Kun Park, MD, PhD said:

“Such changes are likely to have an impact on the reimbursement policy quite a bit even in the other countries, because as you know, 'bad news travels fast' in the recent information society with advanced telecommunications. So, it can lead to a grave international issue.”

We want to bring your attention an issue that may adversely impact patient access to necessary spine fusion procedures: We have learned that North Carolina Blue Cross/Blue Shield Insurance (BC/BS NC) has issued a new, more restrictive policy for lumbar fusion procedures, effective January 1, 2011.

View the Policy Here (PDF)

Our initial read of this policy is that it is overly restrictive; specifically, there are several common scenarios where the standard of care includes fusion; however, this more restrictive policy may make it more difficult for those patients suffering low back pain due to spondylolisthesis to receive needed surgeries. These scenarios include:

• Patients with degenerative spondylolisthesis who don't have as much leg pain as back pain.
• Patients with Isthmic Spondylolisthesis that is not progressive but nonetheless painful.
• Patients where fusion for spondylolysis may be necessary/beneficial in situations where there is no slip and only back pain.
• Patients where fusion is the only procedure that will relieve pain and immobility associated with degenerative disc disease, after 6 months of exhaustive conservative measures have failed.

Note that we have been in contact with both the AANS/CNS and the AAOS, in order to gauge their reaction to this policy. We have also reached out to our industry partners, including Medtronic, DePuy, Synthes, NuVasive, and Spinal Motion, and they plan to express their concerns to BC/BS NC as well. We have also established a dialogue with the NC Orthopaedic Society and the NC Spine Society, as well as the North Carolina Medical Society, and those organizations maintain a dialogue with the medical director of BC/BS NC, and will work with us on any direct communications in-state.

Our goals, therefore, are as follows:

• Short term - develop a letter to BC/BS NC, outlining our concerns with specific provisions of this policy. It is our goal to do this in collaboration with any or all of the NC-based societies mentioned above.
  
• Long term - SAS is in the process of developing a Position Statement on lumbar fusions that we can use in our advocacy efforts, and we welcome any clinical or scientific expertise that you feel may help us in this endeavor.

What we need from you:

We welcome your thoughts on the BC/BS NC lumbar fusion policy, and our intended course of action. Only through the shared insights and support of our members can we be successful in advocating for policies that provide patients with the appropriate access to surgical procedures that will improve their outcomes and quality of life. Please email your comments, concerns and suggestions to Kristy Radcliffe, Executive Director at kristy (at) isass.org.

We continue to identify and address on your behalf policies and actions that unnecessarily limit patients' access to necessary surgical care, and welcome your input on any and all such efforts.

Regards,

Tom Errico, MD
President
SAS - The International Society for the Advancement of Spine Surgery

____________________________________
Below is from Orthopedics This Week:

Dr. Slosar's Blast Email

Note: full text article is posted with publisher approval.
Robin Young • Tue, Dec 7th, 2010
Copyright 2009-2010 RRY Publications

Thirty-eight (and counting) emails piled into my inbox from an impressive list of U.S. spine surgeons last Thursday. Throughout the day, emails streamed in as one surgeon after another banged out their reactions to one, single, particular email.

Dr. Paul J. Slosar’s email.

Dr. Slosar hit the send button on Monday November 29th. “I’d asked my wife to read it before I sent it out. I didn’t want to send out a long and rambling email. But I started thinking about what to say while I was sitting at a faculty conference a couple weeks ago. I’d gotten wind of a new Blue Cross Blue Shield policy on spine fusion reimbursement. Frankly, it made me acutely depressed and angry.”

On Tuesday four guys responded. On Wednesday the responses doubled. On Thursday all hell broke loose. The reaction to Slosar’s email showed that he had tapped into a well of frustration among spine surgeons. Each surgeon post triggered another one, then another one. By mid-day on Thursday, the online dialogue had grabbed the attention of probably a hundred practicing surgeons, a handful of surgery department heads as well as the presidents and boards of the North American Spine Society (NASS) and the ISASS (formerly SAS) and the CEO of one billion dollar spinal implant manufacturer.

The source of this spontaneous group reaction was a proposed spine fusion reimbursement policy from Blue Cross Blue Shield of North Carolina. For some reason the BCBSNC note—more than other recent news, and there has been other policy and reimbursement setbacks for spine surgeons lately—plucked a nerve.

Slosar’s two page “Call to Action” opened with these words: “I apologize for the length of this communication….but (I am writing this because of) my emotional concerns for the health and well-being of my patients as well as my love for my profession.”

Dr. Slosar, 48 years old, conducted his residency at Loyola University in Chicago, has degrees from the University of Illinois/Rush Medical College and is a spine surgeon at SpineCare Medical Group in Daly City, California.

“Dr. Slosar”, I asked, “What was it about this specific Blue Cross Blue Shield policy statement that prompted you to write your note?”

“Where I practice, in Northern California, it is progressively more difficult to get approval for spine fusion surgery. When we ask why we received a rejection letter, we often hear something about the Milliman guidelines which no one seems to have a copy of. We’re getting rejection letters for cases and plans of treatment that we’ve been doing every day for years. Bread and butter stuff. Spine surgeons who treat low back pain have been singled out unfairly.”

“In our clinic I practice state-of-the-art spine surgery using standard indications for lumbar fusions. We get the best results we can for our patients and they are good to excellent with 75-80% of our patients reporting that they are significantly improved and satisfied with their results after fusion surgery. We’ve had elite athletes who are now pain free. Recently I operated on a law enforcement officer who can now return to duty again. I could go on and on.”

“When I heard about and then read this BCBS policy statement it just hit me. I can’t do the job that I have trained my whole life to do. It sucked the wind right out of me. How many patients will have to live lives of debilitating pain because of this proposed policy? I don’t think my patients realize what draconian restrictions are being placed on standard-of-care treatments by the insurance companies.”

The Proposed Blue Cross Blue Shield Spine Fusion Policy

On September 28, 2010, BCBSNC issued a policy statement regarding coverage for lumbar spinal fusion which BCBSNC said would take effect in January 1, 2011. The relevant section is excerpted in the following:

(From the 9/28/10 policy statement from Blue Cross Blue Shield of North Carolina):

When Lumbar Spine Fusion Surgery is covered: BCBSNC will provide coverage for Lumbar Spinal Fusion procedures for any one of the following conditions:

1. Spinal Fracture with instability or neural compression
2. Spinal repair surgery for dislocation, abscess or tumor
3. Spinal Tuberculosis
4. Spinal Stenosis with ALL of the following:
   
   a. Associated spondylolisthesis demonstrated on plain x-rays; and
   b. Any one of the following:
   

   i. Neurogenic claudication or radicular pain that results in significant functional impairment in a patient who has failed at least 3 months of conservative care and has documentation of central/lateral recess/or foraminal stenosis on MRI or other imaging. or
   ii. Severe or rapidly progressive symptoms of neurogenic claudication or cauda equina syndrome.
5. Severe, progressive idiopathic scoliosis (i.e., lumbar or thoracolumbar) with Cobb angle > 40 degrees.
6. Severe degenerative scoliosis with any one of the following:
   
   a. Documented progression of deformity with persistent axial (non-radiating) pain and impairment or loss of function unresponsive to at least 3 months of conservative therapy, or
   b. Persistent and significant neurogenic symptoms (claudication or radicular pain) with impairment or loss of function, unresponsive to at least 3 months of conservative care.
7. Spondylolisthesis, isthmic (type II), with documented progression of slippage, and with persistent back pain (with or without neurogenic symptoms), with impairment or loss of function, unresponsive to at least 6 months of conservative nonsurgical care.
8. Recurrent, same level, disk herniation, at least 6 months after previous disk surgery, with recurrent neurogenic symptoms (radicular pain or claudication), with impairment or loss of function, unresponsive to at least 3 months of conservative nonsurgical care, and with neural structure compression documented by appropriate imaging, and in a patient who had experienced significant interval relief of prior symptoms.
9. Adjacent Segment Degeneration, at least 6 months after previous fusion, with recurrent neurogenic symptoms (radicular pain or claudication), with impairment or loss of function, unresponsive to at least 3 months of conservative nonsurgical care, and with neural structure compression documented by appropriate imaging, and in a patient who had experienced significant interval relief of prior symptoms.
10. Pseudarthrosis, documented radiographically, no less than 6 months after initial fusion, with persistent axial back pain, with or without neurogenic symptoms, with impairment or loss of function, in a patient who had experienced significant interval relief of prior symptoms.
11. Please Note: This policy addresses specifically the circumstances under which arthrodesis (fusion) surgery of the lumbar spine is considered medically necessary. It does not address decompression surgery.

When Lumbar Spine Fusion Surgery is not covered: BCBSNC will not provide coverage for lumbar spine arthrodesis (fusion) surgery when it is considered not medically necessary.

1. Lumbar spine arthrodesis (fusion) surgery is considered not medically unless one of the above conditions is met.
2. Lumbar spinal fusion is also considered not medically necessary if the sole indication is any one or more of the following conditions:

• Disk Herniation
• Degenerative Disk Disease
• Initial Discectomy/laminectomy for neural structure decompression
• Facet Syndrome

Several elements of the BCBSNC statement caught the attention of spine surgeons. Here are the top four.

1. Lumbar spine fusion surgery for degenerative disc disease (DDD) only is not covered—DDD is the most common diagnosis for lumbar fusion surgery. A significant number of patients report debilitating pain as a result of disc degeneration. Prior to the advent of low profile, internal fixation devices, minimally invasive surgical procedures, biologic adjuncts to fusion or advanced nerve monitoring and surgical positioning systems, the predominate indication for lumbar fusion surgery was spinal deformity or extreme instability (spondylolisthesis, trauma or tumor). The BCBSNC policy by disallowing DDD is being perceived as an attack on a “bread and butter” treatment alternative for spine surgeons and would push the practice of spine surgery back to an earlier era.
   
2. Reimbursement is allowed for adjacent DDD but not for primary DDD—It’s hard to understand this distinction. Natural degenerative processes of all aspects of the human musculoskeletal system are well documented in the literature and, to be perfectly plain about it, in the daily practice of medicine. In the case of a perhaps “more noble” degenerative process (osteoarthritis of the hip or knee) there is NO debate regarding reimbursement. But adjacent level disc degeneration instead of primary disc degeneration? Seriously?
   
3. The threshold curvature for scoliosis reimbursement is >40 degrees—According to a small sample of spine surgeons we interviewed, the most recent and best scientific studies indicate that threshold curvature is closer to 30o but that, at any rate, the lumbar fusion surgery decision for scoliosis is multi-factorial and new diagnostic techniques (like ScoliScore) can improve outcomes by employing this multi-factorial approach to patient selection and treatment.
   
4. Lack of peer review science and the appearance of bias in the BCBSNC guidelines—Thousands of peer review journal articles are already available which provide the statistical foundation for improving patient outcomes with surgery when conservative care has demonstrably failed. Instead of looking at those outcome studies, BCBSNC cited articles by long-time fusion critics Deyo and Weinstein to support their guidelines.

ISASS or NASS?

The public forum that flashed into existence from Slosar’s email included comments from and about two of the spine surgeon societies—North American Spine Society and the International Society for the Advancement of Spine Surgery (formerly SAS). ISASS Executive Director Kristy Radcliffe reminded Slosar’s audience that ISASS had sent an email alert regarding the BCBSNC policy before Slosar’s email and was in the process of rallying other societies. Current ISASS President Tom Errico. M.D., who sent out a blast email alert to ISASS members of the BCBSNC pending policy statement said: “I believe that our society, in responding to the North Carolina situation and others like it, needs to take a strong stand at this time.”

NASS Executive Director Eric Muehlbauer watched all of the email traffic on Thursday and then early on Friday weighed in saying: “The most respected organizations are the ones who are strong enough to make reasonable statements, acknowledge weaknesses in arguments and highlight areas where further action and discussion are needed. NASS has been at this a long time. Insurers often come to us for our opinion and we are very judicious about our responses.”

Regardless, the most significant aspect of last week’s spine surgeon email wave is that it occurred spontaneously. In that golden moment the spine surgeon community said very clearly that they are deeply worried and that their core interests are beyond any particular society or company but rather, as Dr. Slosar said, for “…for the health and well being of my patients, as well as my love for my profession.”

[Cindylou]

Well, finally.....what a breath of fresh air!! Surgeon's up and unite! I love it. Put the insurance companies back where they belong, and not dictating policy! They're NOT GOD! Amen to Dr. Slosar's compelling urgency to write this email from the heart, and the resounding applause and response it brought! Thanks for sharing Justin! Cindylou

[Gilbert P]

Justin

Thanks For Sharing

C.L. I agree Get them

Gil;

[KanRunMo]

I read the info but I wasn't sure what SPS had done. Was it that the surgeon(s) got info from SPS logs. I probably skipped something.

[Justin]

I read the info but I wasn't sure what SPS had done. Was it that the surgeon(s) got info from SPS logs. I probably skipped something.

Sorry, I did not spell out the Spine Patient Society's involvement, as I figured Members would read between the lines. Here's what happened: The Spine Patient Society was contacted directly by The International Society for the Advancement of Spine Surgery regarding North Carolina's Blue Cross / Blue Shield policy on spinal fusion surgery, as the were hearing rumors about the proposed policy change.

An associate of The International Society for the Advancement of Spine Surgery contacted me directly on 10/28/10 and asked if I, or the SPS Membership, had heard anything regarding this new policy, as they stated they were "in the info gathering stage." I personally provided The International Society for the Advancement of Spine Surgery with the BlueCross BlueShield of North Carolina's "Lumbar Spine Fusion Surgery 'Notification'." This document was subsequently attached to The International Society for the Advancement of Spine Surgery's email entitled "Alert: Changes to Spine Fusion Insurance Reimbursement Policy" that was released to their Membership on 11/17/10.

The associate replied in an email that "Many thanks for finding this policy...I have shared with all our industry partners, plus other societies like AAOS and AANS, neither of which was aware!"

AAOS = American Academy of Orthopaedic Surgeons
AANS = American Association of Neurological Surgeons

I hope this helps.

[Cindylou]

Again, awesome Justin. What a feather in your cap! CL

[KBear]

Thanks for the explanation, I was lost too... but too prideful to admit it... Great Job.

[Justin]

Here's an excerpt from an email that I received today from SAS—International Society for the Advancement of Spine Surgery (bold and italics are carried over from the email):
_____________________________
Advocacy update – December 6, 2010
Tuesday, 07 Dec 2010 107

Recently, SAS alerted its members to policy changes proposed by North Carolina BC/BS for lumbar fusion procedures. This proposed policy would unfairly reduce or eliminate fusion surgery as an option for many patients who would greatly benefit from such procedures.

Our membership alert has generated a significant response, and will help inform and strengthen our advocacy with North Carolina BC/BS. Indeed, we are now working with myriad other medical societies, our industry partners, and individual surgeons to strongly express our concerns about this overly restrictive policy, and to request that it be modified to ensure patient access to appropriate surgical solutions to spine-related diseases and conditions. Concurrently, we have initiated a process to develop a Position Statement on lumbar fusion and other spine surgery procedures that is based on the latest literature and our members’ and their patients’ experiences – a truly evidence-based approach.

This membership alert has also helped us identify similar payer policies in other states and with other commercial payers that limit patient access to innovative and life-changing surgical procedures. I believe that our society, in responding to the North Carolina situation and others like it, needs to take a strong stand at this time. The current health care environment is clearly prioritising cost-reduction above appropriate patient care, and payers appear to be using a host of confusing tactics and inconsistent strategies to delay or deny spine surgery-related care. Such actions cannot go unchallenged.

As spine surgeons, it is our professional duty to stand up and defend what we do, and to push back against this unfair tide. Our board agrees. In developing our 2011-2015 strategic plan, we recently voted to prioritise Advocacy near the top of our strategic objectives going forward. The situation in North Carolina is a perfect example of the need to add our voice to the debate, and challenge inappropriate policies.

No one else can fight our battles for us. I thank those of you who have provided your perspectives on the North Carolina situation, and who have brought similar situations to our attention. It is important that we stand up now, on behalf of our patients, to oppose these unfair and unjust policies where we find them. Know that your society is willing to fight for you and your patients.

With your help, we can be successful in ensuing that our patients have access to the surgical care that alleviates their pain and suffering, and leads to healthier, more productive lives. It’s the reason why we do what we do.

Thomas Errico, MD, is president, SAS—International Society for the Advancement of Spine Surgery

[Justin]

Orthopedics This Week
Spine Fusion's Line in the Sand

Walter Eisner • Tue, Dec 14th, 2010
Note: full-text is posted with approval.

The flash spine-doc mob has had its virtual and symbolic storming of the castle of Blue Cross/Blue Shield in North Carolina (BC/BS).

Now, the establishment of spine care professionals, including: NASS (North American Spine Society); ISASS (International Society for the Advancement of Spine Surgery, formerly knows as SAS); AANS (American Association of Neurological Surgeons), CNS (Congress of Neurological Surgeons); SRS (Scoliosis Research Society); and perhaps AAOS (American Academy of Orthopaedic Surgeons), will step in to make a quiet, thoughtful and evidence-based case to BC/BS.

The societies will attempt to convince their medical peers at the insurance company that the insurer’s proposed policy of coverage for fusion related to degenerative disc disease (DDD) is too broad and unreasonable and will throw the baby out with the bathwater.

Response Pending

Or as Chris Bono, M.D., one of the lead authors of a letter under development by the spine societies told us, "In trying to stop unnecessary or questionable fusions, the policy will throw out appropriate fusions."

A quick review.

On September 28, 2010, BC/BS issued a policy statement regarding changes in coverage for lumbar spinal fusion that are scheduled to take effect on January 1, 2011. Among other things, the proposed policy stated that lumbar spine fusion surgery for DDD only will no longer be covered. What really seemed to burn some spine surgeons was that the insurer targeted DDD and stated that it was an insufficient diagnosis for lumbar fusion.

The letter under development by Bono and Joseph Cheng, M.D. of AANS is currently being reviewed by the various societies’ policy committees. When completed and negotiated between the societies, a joint letter will be sent to BC/BS. We were told by participants that the goal is to get the letter to the insurer the week of December 13.

Then the politics of influencing an insurance company begins. The politics of who best represents the interests of spine surgeons will also continue.

As former U.S. Speaker of the House Tip O'Neill famously said, "All politics is local." Insurance companies are regulated by state governments and political pressure from surgeons in New York, Chicago and San Francisco doesn't carry a lot of water.

Line in the Sand

Tom Errico, M.D., president of ISASS told us as much. Errico also said he has been trying to reach out to spine surgeons in North Carolina and isn't sure that the local docs are sufficiently engaged to pressure BC/BS.

Errico told us that spine surgeons need to "draw a line in the sand" in North Carolina. But before drawing the line, he said surgeons need to get their heads out of the sand. He sees North Carolina as a stalking horse for all other insurance carriers across the country looking for ways to cut their expenses.

Insurance carriers have a financial self interest at stake. "Where's Senator Charles Grassley in this issue?" asked University of Minnesota spine surgeon David Polly, M.D.

Surgeons aren’t looking for a blank check. Not all fusion surgery performed today delivers consistent and reliable outcomes. Many of the emails from Paul Slosar's "email flash" a couple of weeks ago acknowledged that surgeons and the broader spine community need to do a better job of patient selection and outcome tracking for lumbar fusion surgery.

Collaboration and Calm Urged

One North Carolina surgeon with his head clearly out of the sand is Charles Branch, M.D., a former president of NASS, who is actively involved in responding to BC/BS. Branch is a neurosurgeon at the Wake Forest University School of Medicine

Branch told us that before ranting at BC/BS, spine surgeons need to work collaboratively and thoughtfully to convince the carrier that the proposed policy changes are unreasonable given the evidence.

Branch said that some of the insurer's proposed changes are reasonable, but that key elements are missing. As an example he noted that someone with a severe collapsed disc would not get coverage.

Dr. Bono offered us another example of a hypothetical patient who would be denied reasonable and necessary care under the proposed policy.

The Patient

Louise is a teacher. She is 42 years old and has been teaching for 20 years.

In 2007 she began to experience back pain. After seeing her chiropractor and then her primary care physician without getting rid of the pain, she took a medical leave and stopped working. She suffers from low back pain and some left leg pain attributable to a dysplastic spondylolisthesis.

"Under the current BC/BS policy Louise would have been referred to a spine surgeon who would have OFFERED HER AN L5-S1 FUSION WITH OR WITHOUT A DECOMPRESSION [Bono’s emphasis]. Statistically, her chances of success in eliminating or reducing the pain so that she could go back to work would have been 75%," said Bono.

Under the proposed policy, Louise would not qualify for reimbursement because she didn’t present with an isthmic spondylolisthesis.

“Louise is the patient we want to help,” said Bono.

Now is not the time to ratchet up the rhetoric, said Branch. The societies will make their case to the carrier that revisions to the proposed policy are needed to make it reasonable. How the carrier responds to the evidence submitted by the societies will determine what spine surgeons will do next.

Industry, Physicians and Politics

One industry leader, NuVasive's CEO and Chairman Alexis Lukianov got involved quickly in joining the fray to draw a line in the Tar Heel sand.

Lukianov confirmed to OTW that he pledged $100,000 to ISASS in the Slosar email stream to aid the society in advocacy efforts in North Carolina as well as providing leadership for patient advocacy in Washington, D.C.

We had to ask, "NASS went to bat for you on XLIF. Why $100,000 to SAS and not NASS?"

In an email reply, Lukianov wrote, "SAS stepped up almost immediately and is working to drive positive outcomes. My intent is to help them use whatever means available to work thru North Carolina so there is not a domino effect on January 1, 2011. I am also availing NuVasive's resources both financially, as well as organizationally and functionally, in the way of our expertise."

Lukianov added that there have been "concerning” emails from the reimbursement and advocacy docs at NASS implying they are not in favor of supporting DDD as an indication. "Certainly everyone agrees that back pain without failed and prolonged physical therapy is unlikely to need fusion. There are however very clear DDD indications that can be defended for fusion. A straight out exclusion is not reasonable. That is one reason [for ISASS support].

“Secondly,” said Lukianov, “surgeons are frustrated that NASS is not actively representing surgeons. NASS was once 100% surgeons and is now 60-70% surgeons. SAS is 100% surgeons. NASS has not responded to the BC/BS crisis. When they do we will consider how to support them."

NASS Successes

Dr. Branch bristles at comments that NASS has not been responsive to surgeons. He cited a successful NASS-led response to a Washington State worker's comp policy proposal a couple of years ago that would have limited coverage. He also noted how NASS succeeded in keeping Medicare coverage for fusion intact with evidence presented at a MEDCAC meeting a few years ago.

NASS was also successful in working with a national insurance carrier earlier this year to properly code XLIF procedures and continue providing coverage for the lateral access fusion procedure.

On the Ground

If BC/BS stonewalls and doesn't modify their proposed policy, then local politics in North Carolina take over. Surgeons from outside the state will have very little standing in influencing a local political battle. BC/BS is a giant corporate presence in North Carolina and is regulated by an elected insurance commissioner. It will take our hypothetical Louise to contact the insurance commissioner and her legislator.

There is a Health Care Review Program in North Carolina where, Louise, the insurance policyholder, can request a review of a coverage denial. If Louise is still not satisfied after that, she can request an external review by an independent reviewer. The insurance company is then obligated to follow the findings of that review.

If that fails, then the line in the sand moves to the state's legislature where unions, employers, citizens with back pain and their surgeons can find a sympathetic committee chair to call public hearings.

The decision by BC/BS to propose an "unreasonable" policy change for fusion surgery has incited the most spirited surgeon reaction we've seen in some time. We think Dr. Errico can rest assured that his colleagues have pulled their heads out of the sand and are drawing the line.

In the meantime, the debate over who will be the surgeons' (and patients') most effective advocate continues.

[Justin]

NASS and Multi-Society Coalition Submit Comments on NC BCBS Lumbar Spine Fusion Policy

NASS worked closely with the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) to develop extensive comments on the North Carolina Blue Cross Blue Shield newly issued coverage policy on Lumbar Spine Fusion Surgery.

The policy in question, which is scheduled to take effect January 1, 2011, applies new more restrictive criteria and guidelines for coverage of lumbar fusion procedures.

The multi-society comments applaud the NC BCBS goal of improving patient care through the application of scientifically grounded therapies, but expressed strong concerns regarding the criteria and guidelines for which NC BCBS will provide coverage for lumbar spinal fusion. The letter provides specific suggestions to NC BCBS for modifying its policy to ensure appropriate coverage for those patients who will benefit from lumbar spinal fusion.

In addition to NASS, AANS, and CNS, several other societies signed onto the comment letter including the American Association of Orthopaedic Surgeons (AAOS), International Society for the Advancement of Spine Surgery (ISASS), Pediatric Orthopaedic Society of North America (POSNA), Scoliosis Research Society (SRS), and North Carolina Neurological Society (NCNS). View the letter in its’ entirety here.

© North American Spine Society. All rights reserved.