Advocacy Alert: ISASS to Support SRS Response to BCBS Minnesota Medical Policy IV-85
ISASS will be co-signing with The Scoliosis Research Society (SRS) on the response to Blue Cross Blue Shield of Minnesota's Medical Policy IV-85 for "Bone Morphogenic Protein". The policy severely restricts patient access to BMP. The SRS has called for support from spine societies to contribute to the letter. A link to a copy of Medical Policy IV-85 and a copy of the draft response from SRS are provided below for your review.
BCBS Minnesota Medical Policy IV-85 (PDF) >
Draft SRS Letter
Blue Cross/Blue Shield of Minnesota
On behalf of the Scoliosis Research Society, we are writing you this letter in regards to your medical policy number IV-85, effective 11/23/11, regarding bone morphogenetic protein. The Scoliosis Research Society (SRS) is a group of over 750 surgeons from around the world who are the leaders in treatment of spinal deformity. Our mission is to foster optimal care for both children and adults with spinal deformities. Part of this mission includes advocating for access to excellent care, and appropriate insurance coverage policies, for spinal deformity patients.
Our concern with your updated medical policy is two-fold. The first issue involves the lack of a transparent and clearly elucidated rationale for the decision to severely restrict access to BMP. Whether or not the decision is correct, a critical tenant of evidence-based decision making is that the methodology and process are available for review and discussion. Governmental agencies, private payers and medical societies, including the SRS, have advocated for evidence-based standards as part of the conversion to a value based healthcare system. We strongly believe that this approach must be applied in a fair and uniform manner. It is unreasonable to hold physicians to a standard of transparency and academic rigor if BC/BS is permitted to make payment decisions based upon a nontransparent and ill-defined process.
Our second concern is with the segment of the policy which indicates that the use of BMP would result in loss of coverage for the underlying procedure and the hospitalization. We believe this to be completely unjustified and inappropriate. In particular, this policy puts patients with severe and complex spine deformities for which BMP may be a necessary component of their treatment regimen at risk for inadequate medical care. We certainly understand the need to balance resource utilization and cost effectiveness as part of the clinical decision making process. Spine deformity procedures are resource intensive, and deformity surgeons address these issues with their patients, their hospitals, and payers, on a daily basis. Whether or not BC/BS of Minnesota finds it necessary to restrict payment for a device that it deems too costly, it is unconscionable to use that as a basis in denying payment for the underlying medically necessary procedure.
We urge you to reconsider this policy, and would be happy to discuss any of these issues further.
The Scoliosis Research Society
The International Society for the Advancement of Spine Surgery