Controversy over treatment types, overly generous payments to physicians to endorse a product, lawsuits alleging faulty research, the FDA under fire for inadequate evaluation, fights over reimbursement for a new procedure, and confusion over the usefulness of a common and very expensive procedure.
If you want to know why the US health care system is so dysfunctional, I give you low back pain.
First, there is little agreement on treatment options. Choices range from NSAIDs and bed rest to PT to spinal fusion to disk replacement, with costs and implications from nil to millions.
Physicians (sort of) agree that over the long term, spinal fusion for low back pain is not likely to be any better than other, cheaper alternatives. This came out of a panel discussion set up by Medicare, attended by a number of physicians, some of whom are paid by implant manufacturers.. You won’t be surprised that the panel decided more study is needed.
Next. filthy lucre’s impact. One of the larger manufacturers of implants, Medtronic, paid a $40 million fine last year to settle charges that it had paid physicians to use Medtronic devices. The payments were in the form of excessive travel reimbursements, hefty perks, and outright bribes.
Johnson and Johnson’s Charite artificial disk has been used for several years to treat patients with degenerative disk conditions. Approved by the FDA after a 2 year study period, the implant has come under withering assault from critics who contend it was not adequately tested, fails at an unacceptably high rate, and is no better than a previously-discarded alternative. The furor now involves the FDA, which is accused of ramming through the approval process for the controversial treatment.
Meanwhile, the volume of back surgeries has grown significantly over the last few years. It also varies widely by geography; you are six times as likely to have back surgery if you live in Bend Oregon than if your residence is near Yankee Stadium.
Fortunately, a well-designed evaluation of back surgery and alternative treatments is underway at Dartmouth. The study, which is investigating outcomes from surgical and non-surgical treatments for severe back pain caused by a herniated disk, has found that patients “do improve after getting a lumbar diskectomy–the surgical removal of part or all of the disk–but only slightly faster and better than people who don’t get the surgery.”
And for a caustically witty take, read Matthew Holt’s very funny piece on ethics and surgeons (the two are not necessarily oil and water)
I was awarded my PTD in 9-93.After West Virginia Workers Compensation was taken over by Brick Steet Adimisstration Services I now have my Medical Authorizations made by Cambridge Integrated Services Group. Can anyone tell me why?
They are successful at not paying bills and getting away with it. I have a lifetime injury case whereby I was awarded medical with no money for compensating the injury so expected to have my medical treatments taken care of…..they have continually harassed and not paid doctors or provided medication, etc.
They are the epidomy of what “Sicko” the famous documentary depicts as Insurance Agencies run a much in this country and whose minding the store?
Who is protecting the rights of the injured workers?