Public Policy and AdvocacyMay 2013 - Domagoj Coric, MD Responds to BCBSNC “Let’s Talk Cost” Statement on Artificial Discs I am writing you on behalf of International Advocates for Spine Patients (IASP) as well as the patient population of North Carolina. IASP is an organization supported by physicians and patients dedicated to advocacy for high quality, widely accessible and cost effective spine care for patients around the world. I am on the Board of IASP (a sister organization to the International Society for the Advancement of Spine Surgery-ISASS) which was formed in 2011 to complement ISASS’ educational and scientific mission through direct advocacy efforts on the behalf of spine patients. I have spent the last 30 years in NC, generally working in healthcare or related fields. [...] I am writing to express serious concerns about numerous factual inaccuracies and omissions on the Blue Cross Blue Shield of North Carolina “Let’s Talk Cost” web site. Read More » 
March 2013 - ISASS Statement on Vertebral Augmentation To: ISASS Members and the General Spine and Medical Communities It is estimated that over 1.4 million people will develop vertebral compression fractures every year (Johnell & Kanis 2006). Many will be clinically insignificant or heal with non-operative treatment. A large group will have persistent pain, kypholic deformity, weight loss, depression and a reduced quality of life. (Old & Calvert 2004; Borgstrom et al. 2006; Suzuki et al. 2008). Open surgical intervention is used when there is severe deformity, instability, or neurologic compromise. Vertebral augmentation such as Vertebroplasty (VP) and balloon kyphoplasty (BKP) are minimally invasive techniques used to treat painful vertebral compression fractures. There is good evidence that these techniques can provide immediate and lasting pain relief (Berlemann et al. 2004; Grafe et al. 2005; Groh et al. 2005; Alvarez et al. 2006; DeNegri et al. 2007; Lovi et al. 2009; Schofer et al. 2009; Wardlaw et al. 2009; Klazen et al. 2010; Liu et al. 2010; Santiago et al. 2010; Boonen et al. 2011). At the same time there is evidence that not all patients with vertebral compression fractures benefit from these procedures (Buchbinder et al. 2009; Kalmes et al. 2009; Rousing et al. 2009; Wardlaw et al. 2009; Klazan et al. 2010). Technology assessment efforts and meta-analyses have arrived at different conclusions regarding the value of vertebral augmentation, but are based on different studies depending on the timing of analyses and publications (Taylor et al. 2006a,b; Hulme et al. 2006; Eck et al. 2007; AAOS 2010; Papanastassiou et al. 2011). Read More »
December 2012 - Advocacy Alert: Member Input Needed: Federal AHRQ to Review Comparative Effectiveness for Spinal Fusion The US Agency for Healthcare Quality and Research (AHRQ) has taken up a comparative effectiveness review of "Spinal Fusion for Treating Painful Lumbar Degenerated Discs or Joints." They recently released a draft report and have provided a public comment period with a deadline of December 18, 2012. ISASS is encouraging our members to provide comments to AHRQ. Read More »
November 2012 - Advocacy: 2013 Physician Fee Schedule Finalized - CMS Assigns Valuation to Pre-Sacral Fusion Code ISASS Thanks our Members for Stepping Up On November 1st, the Centers for Medicare & Medicaid Services (CMS) released the 2013 Medicare Physician Fee Schedule final rule. Of particular note to ISASS members is CMS' decision to assign a valuation ('relative value units') to a recently approved Category I CPT® code 22586: pre-sacral interbody fusion at L5-S1. Earlier this year, ISASS supported the transition of this procedure code to Category I status from its Category III status since the procedure had satisfied the criteria necessary for such a code transition. After the Editorial Panel had voted in favor of establishing the Category I code for pre-sacral interbody fusion, other spine-related medical societies declined to participate in a member RUC survey to establish physician valuation for the procedure. ISASS however realized the importance of appropriately valued procedures to its spine surgeon members, and agreed to conduct a survey of our members to collect the appropriate data for CMS to establish valuation for this procedure. Read More »
October 2012 - Advocacy: ISASS Joins the AMA and 100+ Medical Societies in SGR Transition Principles Letter The AMA and more than 100 state and medical specialty societies - including ISASS - issued a set of principles that can support a federal transition from the sustainable growth-rate formula to a “higher performing Medicare program.” In an Oct. 15 letter to Congressional Leaders, the groups called for lawmakers to repeal the Medicare physician payment formula, arguing that eliminating the SGR formula is essential to the development of a high performing Medicare program. Read Letter »
September 2012 - Advocacy Alert: Washington State Health Care Authority Seeking Input on Cervical Spinal Fusion for DDD The office of Health Technology Assessment in the state of Washington has commissioned a health technology assessment of cervical spinal fusion for degenerative disc disease, in order to compare the clinical benefits, potential harms, and economic impact of cervical fusion procedures to conservative management and other treatment alternatives. Read More »
July 2012 - The Spine Movement - Spine ASCs and Meeting The Existence Theorem From the June 2012 Special ASC Issue of the ISASS monthly newsletter The Spine Movement: Dr. Morgan Lorio, Chair of the ISASS Coding & Reimbursement Task Force tackles a few of the larger issues in spine ambulatory surgery. Read More »
June 2012 - The Spine Movement - Coding Challenges Loom Large in 2012 From the June 2012 Special Advocacy Edition of the ISASS monthly newsletter The Spine Movement: Dr. Morgan Lorio, Chair of the ISASS Coding & Reimbursement Task Force, gives a look at concrete examples of the increasingly difficult environment for spinal procedures. Read More »
June 2012 - The Spine Movement - Important Changes to the CPT Coding of Minimally Invasive Surgery From the June 2012 Special Advocacy Edition of the ISASS monthly newsletter The Spine Movement: Dr. Choll Kim examines the ever trickier coding landscape as it relates to Minimally Invasive Surgery. Read More »
June 2012 - ISASS Response to US Supreme Court Ruling on PPACA In response to the US Supreme Court's ruling on the constitutionality of the Patient Protection and Affordable Care Act (PPACA), ISASS President Steven Garfin, MD has issued the following statement: ISASS remains committed to working on behalf of our US-based spine surgeons to ensure that the PPACA is implemented in ways that ensure our patients' access to medically indicated and appropriate spine surgeries and procedures.... Read More »
June 2012 - Advocacy Alert: New York Spine Surgeons - Action Required Legislation is pending in NY that will require out-of-network reimbursement rates to be tied to properly established UCR rate calculations (as opposed to inadequate bench-marking information). The New York State Society of Orthopaedic Surgeons (NYSSOS), together with the Medical Society of the State of New York (MSSNY), is seeking advocacy input from all NY-based spine surgeons and related health care professionals, scientists and researchers. Read More »
June 2012 - ISASS Coding & Reimbursement Task Force Member Barbara Cataletto writes "6 Months Later – How Are You & the New Spine Codes Doing?" for Becker's Spine Review "So now we are months into the new CPT code changes for spine for 2012. If you were able to get this far without losing your mind or quitting your job, then you must be a real trooper! There have been so many issues surrounding the implementation of these codes in all sectors of the industry. Practices need to adjust op notes, authorizations and coding programs." Read More »
May 2012 - The Spine Movement: The Big Picture: ISASS Advocacy Efforts From the May 2012 Special Advocacy Edition of the ISASS monthly newsletter The Spine Movement: David Porter - ISASS Director of Public Policy & Advocacy - discusses the history, future, and many directions of ISASS work on helping surgeons receive appropriate reimbursement and helping patients receive the best possible care. Read More »
May 2012 - The Spine Movement: Stepping Up, State by State From the May 2012 Special Advocacy Edition of the ISASS monthly newsletter The Spine Movement: Gunnar Andersson, MD, PhD - ISASS Board of Directors - points out that pushing for policy isn't that different from your practice: as always, the patient's well-being is the first concern. "There's no question in my mind that we are stronger as a group than we are as individuals... we need to unify in ISASS and make our voice heard both on a national and local level." Read More »
May 2012 - Advocacy Alert Update: Official ISASS Response to HCSC Draft Policy ISASS President Steven Garfin, MD, submitted the official ISASS response to HCSC, the parent corporation for Blue Cross/Blue Shield plans in Illinois, New Mexico, Oklahoma, and Texas, and the new draft policy for Lumbar Spinal Fusions. "With the promulgation of this policy, those patients may now lose the opportunity of a clinically meaningful improvement. Given that all patients are different, sweeping policy statements will exclude properly selected patients from receiving appropriate clinical care." Read More »
May 2012 - ISASS Launches IASP Website at SpinePatientAdvocacy.org ISASS is pleased to announce that the website for our new advocacy organization International Advocates for Spine Patients is now open. Read More »
May 2012 - Advocacy Alert Update: ISASS President Steven Garfin, MD Rebuts HCSC/BCBSIL Draft Policy Changes for Lumbar Spinal Fusion Surgery ISASS President Steven Garfin rebuts the HCSC/BCBSIL draft policy changes noted in last week's advocacy alert. "While many patients with degenerative disc disease or facet syndrome will not have that diagnosis as their sole indication, there are patients with chronic low back pain who have not responded to appropriate non-operative treatment and who will benefit from a surgical procedure. Those patients may now lose the opportunity of a clinically meaningful improvement." Read More »
May 2012 - Advocacy Alert: HCSC Drafts New Policy for Lumbar Spinal Fusions Earlier this week, HCSC, the parent corporation for Blue Cross/Blue Shield plans in Illinois, New Mexico, Oklahoma, and Texas, issued a new draft policy for Lumbar Spinal Fusions. Concerns have been raised that this new policy rules out access to lumbar fusion for patients where the sole indication is a disc herniation or neurostructure compression (initial discectomy / laminectomy), and patients with a sole indication of degenerative disc disease or facet syndrome. ISASS is preparing a response to HCSC and recommends that spine surgeons in those states review the draft policy and respond at the local level before the May 31, 2012 deadline. Read More »
May 2012 - ISASS Presentation to Simmons Surgical Society by David Porter Presentation by David B. Porter, ISASS/IASP Director of Public Policy and Advocacy, describing advocacy efforts for spine surgeons and patients, the "Trident" of Advocacy and more at the Simmons Surgical Society 33 Annual Meeting. Read More »
April 2012 - Advocacy Alert: ISASS Letter to CMS Division of Outpatient Care Regarding the Removal of Cervical Disc Arthroplasty from the Medicare "Inpatient Only" List ISASS President Steven Garfin, MD, has written a response to the Centers for Medicare & Medicaid Services Division of Outpatient care regarding the agency considering the removal of cervical disc arthroplasty from the Medicare "Inpatient Only" list. "ISASS supports Medicare policies that will help spine surgeons deliver better and novel treatments to our patient population. Our experiences have shown us that cervical disc arthroplasty in selected patients can be safely performed in the outpatient setting, just as cervical fusion is now being conducted." Read the Full ISASS Letter to CMS Division of Outpatient Care »
March 2012 - Advocacy Alert: BCBS Minnesota Revises BMP Medical Policy IV-85 Orthopedics This Week is reporting that the Scoliosis Research Society and ISASS advocacy efforts regarding BMP Medical Policy IV-85 have resulted in review and change of their controversial policy. BCBS Minnesota "has rescinded a recent controversial policy of denying payment for ANY part of a surgery if BMPs are used off-label. [....] BCBS's Vice President and Chief Medical Officer, Greg Gilmet, M.D., M.P.H., made good on the promise to consider revisions and informed SRS that the previous controversial policy was, 'reviewed, modified, and posted,' on the company's website, effective March 9, 2012." Read More at Orthopedics This Week » See Also: Advocacy Alert: ISASS to Support SRS Response to BCBS Minnesota Medical Policy IV-85
March 2012 - Advocacy Alert: ISASS Joins 370 Organizations in Calling for Repeal of IPAB ISASS has signed a letter with hundreds of other organizations, expressing support for the complete repeal of the Independent Payment Advisory Board, which was included in the Patient Protection and Affordable Care Act legislation. "We all share the conviction that the Independent Payment Advisory Board (IPAB) will not only severely limit Medicare beneficiaries’ access to care but also increase healthcare costs that are shifted onto the private sector."
March 2012 - Advocacy Alert: ISASS Comments to AHRQ - Spinal Fusion for DDD or Joint Disease "We welcome the opportunity to comment on the key questions AHRQ might pose as they undertake a review of spinal fusion for lumbar degenerative disc or joint disease. As a scientific, educational and advocacy organization, we remain committed to insure that subsequent AHRQ recommendations around lumbar spinal fusions for degenerative disc or joint disease do not unfairly or unnecessarily limit patient access to medically indicated surgeries that can improve patient outcomes, reduce or eliminate chronic pain, and accelerate a patient’s return to a satisfying and productive life."
February 2012 - 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. Read More »
February 2012 - Advocacy Alert: Doc Fix Tentative Deal Reached The LA Times is reporting that federal lawmakers have reached a tentative agreement today on a payroll tax holiday bill to avert a 27%+ cut in Medicare physician payment rates. The agreement would extend the current rates through the end of 2012. ModernHealthCare.com is reporting that the agreement also extends certain Medicare programs while making $11+ billion in cuts to the Patient Protection and Affordable Care Act. Read More »
February 2012 - Advocacy Alert: New Jersey State Spine Society Emergency Meeting Dr. Mitchell Reiter, President NJSSS, has called for an emergency meeting to be held on on February 15, 2012 at the Sheraton Tara Hotel, 199 Smith Road, in Parsippany, New Jersey. Major issues have arisen from proposals by Horizon Blue Cross and Blue Shield of New Jersey and Cigna that will dramatically reduce reimbursement rates for spine procedures. The meeting is being held to collect input and activate spine surgeons in New Jersey to address this direct and specific attack on spine procedure reimbursement. Read More »
February 2012 - Video: Dr. Morgan Lorio's AHRQ Testimonial ISASS Coding and Reimbursement Task Force Chair Morgan Lorio, MD has posed a video testimonial response to the AHRQ: Comments on Key Questions: "On July 12, 1982 at 10am I fell approximately 35 feet at work from scaffolding and literally broke my back. I recovered from the fractures but suffered from an insidious onset of low back degenerative disc disease. This problem was underscored in 1997 as I required an L5/S1 diskectomy for left leg radiculopathy. My leg pain was greatly improved but my back pain worsened. By 2005 I was wearing a TENS unit ramped up to the maximum and requiring cortico-steroids and anti-inflammatory treatments to have anything akin to a normal life." Read More / Watch Video »
February 2012 - Advocacy Alert: Call to Action from ISASS Coding and Reimbursement Task Force Chair Morgan Lorio, MD "It has been brought to my attention that YOUR IMMEDIATE ACTION IS REQUIRED regarding a time sensitive notice issued by the Agency of Healthcare Research and Quality (AHRQ). Summarized, AHRQ has requested comments on spinal fusion for painful lumbar degenerative disc or joint diseases. It is our timely duty, and it is imperative that we respond with a strong front supporting the care of our spinal patients. As spinal surgeons, we must be actively involved in this worthy endeavor. "I STRONGLY ENCOURAGE YOUR ACTION. ISASS will forward a statement with the ISASS Lumbar Fusion Policy Statement. I plan to formulate my own testimonial this week in both written and YouTube format. I implore each of you to act as well – every spinal surgeon member should send any support letter, article, case experience, and/or testimonial available to AHRQ." Read More » Related Links: AHRQ: Comments on Key Questions ISASS Policy Statement on Lumbar Fusion Surgery
January 2012 - ISASS Coding and Reimbursement Task Force "The ISASS Board is pleased to announce that Morgan P. Lorio, MD, FACS, of Bristol, Tennessee, will chair the new Coding & Reimbursement Task Force. Dr. Lorio is in private practice, and also is an assistant clinical professor at East Tennessee State University." "The Coding & Reimbursement Task Force is charged with: 1.) identifying spinal surgery-related coding and reimbursement issues that may adversely impact patient access to medically indicated spine surgeries; 2.) developing for the Board's approval advocacy action plans on the society's behalf to address those issues; and, 3.) assisting in the execution of those advocacy actions plans as appropriate and necessary." Read More »
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