By John Ballard
The story was on the radio yesterday and the word is getting out.
Complicated and expensive back surgery is not only expensive, it may also be more dangerous than less dramatic approaches to back pain management.The AMA release can be found lots of places but this one is from Business Week.
Complex back surgeries in older adults surged 15-fold from 2002 to 2007, driving up medical costs and the risk that patients may develop life-threatening complications, a study found.
The operation, complex spinal fusion, accounted for 14.6 percent of all back surgeries for Medicare patients in 2007, up from less than 1 percent in 2002, researchers said today in the Journal of the American Medical Association. Patients who underwent the procedure showed a doubled rate of life- threatening complications, 5.6 percent, compared with a simpler back surgery called decompression.
The study is the first to look at the rate of spinal surgery and its complications and cost in a large group of Medicare patients, said the lead researcher, Richard Deyo. About 660,000 back surgeries, some of which use devices made by Medtronic Inc. and Zimmer Holdings Inc., were performed in the U.S. in 2009, according to Millenium Research Group, a medical market research company in Toronto.
�This is an example where lower-cost procedures are just as good and safer, as well as being less expensive,� Deyo, a researcher at Oregon Health & Science University in Portland, Oregon, said in a telephone interview.
The more complicated surgery generated average hospital charges of $80,888 compared with an average of $23,724 for the simpler operation, the research found.
Naomi Freundlich, writing at Health Beat, fleshes out the report thus.
...in the simple decompression surgery there are no profits to be made from implants, devices or proprietary biological materials. In the complex surgeries, charges for implants alone can exceed $50,000. With Medicare footing the bill, doctors get paid more for the complex procedure, hospitals get paid more and medical device companies eagerly watch their profits grow. But there is another, more serious downside from the patient�s point of view: According to the JAMA paper, the complex spinal surgeries carry greater risk of death, serious complications and long-term problems and so far have not proven to be more beneficial than simple decompression.
An article last year in the Journal of the American Board of Family Medicine documented enormous growth in tests and treatments targeting back pain including �a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates.� Despite the dramatic increase in interventions, there is little evidence that patients are reaping the benefits: the rate of disability from back pain was even higher in 2005 than in 1997.
In 2007, spinal surgery was number one on Consumer Reports� list of the top 10 overused medical tests and treatments. �In 90 percent of cases, the pain goes away on its own within six weeks,� wrote the authors of the report.
Richard Deyo, Kaiser Permanente professor of evidence-based family medicine at Oregon Health & Science University and lead author of both the new JAMA paper and the Family Medicine article told Newsweek last year:
"We seem to be doing more and more"� �[But] there's no evidence that people are getting more pain relief." He continues, "This suggests to me that we're overtreating a lot of people, and we're providing a lot of services that may not be very beneficial."
Not much news here for those who have been doing their homework. But it is reassuring to see the medical community putting out more information along these lines and journalists paying more attention for a change.
That Consumer Reports list of ten overused tests and treatments might be a good one to keep in your pocket next time you go to the doctor. You may need one of them (or not) but at least you will know to ask a question or two, perhaps getting a second opinion. (And when's the last time you heard that term, much less got one? Ya think the cost of yet another office visit might have something to do with it?) Look closely at the url and you will find the term "medical ripoffs." Fuller explanations of each can be found at the source.
10 overused tests and treatments1
BACK SURGERY.
2
HEARTBURN SURGERY.
3
PROSTATE TREATMENTS.
4
IMPLANTED DEFIBRILLATORS.
5
CORONARY STENTS. .
6
CESAREAN SECTIONS.
7
WHOLE-BODY SCREENS.
8
HIGH-TECH ANGIOGRAPHY.
9
HIGH-TECH MAMMOGRAPHY.
10
VIRTUAL COLONOSCOPY.
I know I am tickled pink with my back surgery :) I had to wait years because of being under work comp, I would have been happier if it had been approved earlier! My doc tho believes that time usually takes cares of most back problems.
ReplyDeleteMy wife is also the beneficiary of back surgery done over twenty years ago. She, like you, was the perfect candidate.
ReplyDeleteIt is clearly indicated for some patients, and I know how tight-fisted workers comp can be. During a long career in the food business I saw numerous examples of both companies and/or their insurance carriers making harsh decisions just to same money.
Part of the problem has been uninsured employees who sometimes want workers comp to cover medical bills not related to employment. I'm thinking of an example I know about of someone who sustained an ankle fracture at home and claimed it happened at work. And I was told that in Georgia if an employee is hired with a medical condition, workers comp is responsible if working conditions "aggravated or made worse" that problem.
Universal health care should start changing that situation. Here is a link to an interview with Joe Paduda who is an expert on the subject. It runs about nineteen minutes.