#490 ISASS Advocacy with Public and Private Payers

General Session: Quality of Spine Care

Presented by: M. Lorio

Author(s):

M.P. Lorio (1)
K. Radcliffe (2)
D. Porter (3)

(1) Neuro-Spine Solutions, Bristol, TN, USA
(2) ISASS, Aurora, IL, USA
(3) ISASS, Evanston, IL, USA

Abstract

Goal/Mission: To address the unmet needs of spine surgeons, spine patients, and the spine industry in identifying and responding to public and private payer policies that adversely impact patient access to medically indicated surgical care. The ISASS Task Force for Coding & Reimbursement was created in January 2012 to provide society members with a deliberative platform to better understand spine surgery coverage, payment and reimbursement issues, and to enable adaptive, productive responses to public and private payer policies.

The Task Force is designed to meet this goal through regular interaction, consideration of important issues, and issuance of policy statements, letters, and testimony where applicable. This abstract provides an overview for 2012 activities.

The challenge for ISASS is to advocate for spine patient access in an environment focused on cost. Payers' coverage policies/reimbursement are said to be based on “evidence-based medicine;” our members' experiences, however, demonstrate escalating restrictive policy response to spinal surgeries.

Spiraling costs have brought downward pressures to physician reimbursement; shifted more cost to patients; while limiting patient access to emerging technologies. ISASS advocacy seeks to meet unrecognized, unanswered, and unmet needs of spine surgeons while supporting innovation in overall spine health.

Methods: ISASS Task Force members comprise 12 practicing surgeons, and five non-MD coding/reimbursement consultants with extensive knowledge of, and experience in coding and coverage issues.

The Task Force identifies detrimental spine payer policies/decisions. The Task Force then develops responses based on best: evidence, spine surgeons' practices/experiences, and patient values. The Task Force also serves to educate ISASS members via multiple communicative modalities.

A chronologic, retrospective list of Task Force achievements was analyzed to assess trends in spinal surgery coverage issues, and review society priorities and advocacy activities.

Conclusion/Vision: An active, aware, scientific, evidence-based member-led transparent voice is vitally necessary to preserve the current quality of spine health. The Task Force seeks to advocate on behalf of our surgeon members to ensure unfettered access to, and appropriate reimbursement for, medically appropriate spinal surgeries that will improve patients' lives. ISASS actively seeks admission to the AMA House of Delegates, which affords the society official participation in the CPT Editorial Panel processes, as well as the AMA/Specialty Society Relative Values Update Committee (“the RUC”). As a Task Force, we must be “nimble and quick” in responding to policy proposals that adversely affect patient access to life-improving spinal surgeries. Additional work needs to be done…

1) to enhance ISASS ability to undertake systematic reviews and analysis of the latest literature, and

2) to broaden ISASS official public policy positions.

This work will enable an expanded ISASS voice in public discourse.

Figure: Results