June 17, 2015

Advocacy Alert: WPS Medicare Draft LCD

Action Alert! Attention ISASS Members within WPS Medicare Jurisdiction: Michigan, Indiana, Iowa, Nebraska, Missouri and Kansas WPS Medicare – Proposed non-coverage decision – DL35994 – Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain On April 1, 2015, Wisconsin Physicians Service Insurance Corporation (WPS Medicare) issued a proposed non-coverage determination for minimally invasive sacroiliac joint fusion (MIS SIJ fusion). According to its draft Local Coverage Determination (LCD), WPS Medicare believes that the SI joint is a controversial source of primary low back pain and cannot be effectively isolated as a pain source. Additionally, WPS Medicare states that fusion/stabilization of the SI joint for the treatment of back pain presumed to originate from the SI joint is […]
June 7, 2012

Advocacy Alert: New York Spine Surgeons – Action Required

To all ISASS New York Colleagues, 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. First and foremost, NY-based spine surgeons and their respective professional associations are urging support of bill S. 5068-B and A. 7489-B, now being considered in the NY Assembly and Senate. This bill “prohibits approval of a health maintenance plan that does not include coverage of out-of-plan medical services; requires every health maintenance organization […]
May 31, 2012

Advocacy Alert Update: Official ISASS Response to HCSC Draft Policy

2012 – 2013 ISASS BOARD OF DIRECTORSPresident Steven Garfin, MD, USA Incoming President Luiz Pimenta, MD, Brazil Treasurer Gunnar B. J. Andersson, MD, PhD, USA Michael Ogon, MD, Austria Hee Kit Wong, MD, PhD, Singapore Jeffrey Goldstein, MD, USA Immediate Past President Jean-Charles LeHuec, MD, France ISASS Past Presidents Thomas Errico, MD, USA Chun-Kun Park, MD, PhD, South Korea Karin Büttner-Janz, MD, PhD, Germany Hansen A. Yuan, MD, USA Stephen Hochschuler, MD, USA Founding Member Thierry Marnay, MD, France Founding Member Rudolf Bertagnoli, MD, Germany Founding Member (the late) Charles Ray, MD, USA Founding Member 2013 Program Chairs Overall Program Chair Chris Bono, MD, USA Basic Science Chair Donna Ohnmeiss, DrMed, USA Clinical Science Chair Rick Sasso, MD, USA MIS […]
May 21, 2012

Advocacy Alert Update: ISASS President Steven Garfin, MD Rebuts HCSC/BCBSIL Draft Policy Changes for Lumbar Spinal Fusion Surgery

HCSC/BCBSIL’s draft policy is moderately onerous in the sense that most indications for a spinal fusion are still covered. The areas where lumbar spinal fusions procedures “are not considered medically necessary” include patients where the sole indication is a disc herniation or neuro structure compression (initial discectomy/laminectomy) “as well as” degenerative disc disease and facet syndrome. This is the area where the primary controversy exists. 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. […]