We wanted to bring your attention to an issue that may adversely impact patient access to necessary spine fusion procedures. We have learned that North Carolina BC/BS has issued a new, more restrictive policy for lumbar fusion procedures, effective January 2011.
View the Policy Here (PDF) (Note: Policy document removed from BC/BS NC web site.)
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:
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 NC BC/BS 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 NC BC/BS, and will work with us on any direct communications in-state.
Our goals, therefore, are as follows:
What we need from you:
We welcome your thoughts on the NC BC/BS lumbar fusion policy, and our intended course of action. Only through the actions of NC-based surgeons 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 any comments to Kristy Radcliffe, Executive Director at firstname.lastname@example.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.
Tom Errico, MD
SAS – The International Society for the Advancement of Spine Surgery