Advocacy Alert: SAS Will Engage Payers on Spine Surgery-Related Procedures

Advocacy Alert: Changes to Spine Fusion Insurance Reimbursement Policy
November 17, 2010
Advocacy Alert: BCBS/NC Lumbar Fusion Response
December 15, 2010
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Recently, SAS alerted its members to policy changes proposed by North Carolina BC/BS for lumbar fusion procedures. This proposed policy would unfairly reduce or eliminate fusion surgery as an option for many patients who would greatly benefit from such procedures.

Our membership alert has generated a significant response, and will help inform and strengthen our advocacy with North Carolina BC/BS. Indeed, we are now working with myriad other medical societies, our industry partners, and individual surgeons to strongly express our concerns about this overly restrictive policy, and to request that it be modified to ensure patient access to appropriate surgical solutions to spine-related diseases and conditions. Concurrently, we have initiated a process to develop a Position Statement on lumbar fusion and other spine surgery procedures that is based on the latest literature and our members’ and their patients’ experiences – a truly evidence-based approach.

This membership alert has also helped us identify similar payer policies in other states and with other commercial payers that limit patient access to innovative and life-changing surgical procedures. I believe that our society, in responding to the North Carolina situation and others like it, needs to take a strong stand at this time. The current health care environment is clearly prioritizing cost-reduction above appropriate patient care, and payers appear to be using a host of confusing tactics and inconsistent strategies to delay or deny spine surgery-related care. Such actions cannot go unchallenged.

As spine surgeons, it is our professional duty to stand up and defend what we do, and to push back against this unfair tide. Our board agrees. In developing our 2011-2015 strategic plan, we recently voted to prioritize Advocacy near the top of our strategic objectives going forward. The situation in North Carolina is a perfect example of the need to add our voice to the debate, and challenge inappropriate policies.

No one else can fight our battles for us. I thank those of you who have provided your perspectives on the North Carolina situation, and who have brought similar situations to our attention. It is important that we stand up now, on behalf of our patients, to oppose these unfair and unjust policies where we find them. Know that your society is willing to fight for you and your patients.

With your help, we can be successful in ensuing that our patients have access to the surgical care that alleviates their pain and suffering, and leads to healthier, more productive lives. It’s the reason why we do what we do.

Thomas Errico, MD
President
SAS-International Society for the Advancement of Spine Surgery