Back surgery is far too common, far too risky, and far too costly – it’s also far from proven effective for most conditions.
That’s why Minnesota’s decision to educate workers’ comp claimants contemplating back surgery is a great example of legislators and regulators getting it right. The legislature passed SB1234 which among other things called for a two-year pilot program:
“for employees with back injuries who are considering back fusion surgery. The purpose of the program is to ensure that injured workers understand their treatment options and receive treatment for their work injuries according to accepted medical standards. The services provided by the patient advocate shall be paid for from the special compensation fund.”
The program’s Patient Advocate helps claimants determine if lumbar fusion surgery is appropriate, educates them about the risks (only half get better after surgery, about a third have a “poor” result), complications, likelihood of repeat surgery (about 25% get another surgery), and poor outcomes (less than half return to work).
This makes so much sense on so many levels. The research indicates PT and anti-inflammatories deliver better outcomes than surgery for degenerative disk disease, probably the most common cause of low-back pain. That’s not to say surgery isn’t the right treatment for some; a government research project indicates patients getting surgery for herniated disks have better outcomes in all categories except one – return to work.
Leaving aside that rather big caveat, this is exactly what the workers’ comp system needs – more science, better educated claimants, and a clear and understandable discussion of potential risks and benefits prior to aggressive treatment.
I’d be remiss if I didn’t note the State of Washington dealt with lumbar fusion some years ago, requiring conservative care before contemplating surgery and banning multiple level lumbar fusion for patients with no prior lumbar surgery.
Hat tip to WorkCompCentral for the head’s up.
What does this mean for you?
See, legislators and regulators can – and do – get it right.
Joe — the fact sheet on fusions (http://www.dli.mn.gov/wc/pdf/fact_sheet_lumbar_fusion.pdf) is something we’d like to convince other states to start using too. Advice coming from the government, seems to be accepted more than counsel from an insurance company…
Mike – hard to believe folks look more kindly on gubmint advice than IN-shuranz cumpnies!
This is really great, kudos to MN for taking a proactive approach to managing chronic back pain and educating the patient. According to Dr. Deyo (J Am Board Fam Med 2009; 22:62-68), studies have documented “a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates.” These increases have not shown improvements in patient outcomes or disability rates. Another good study (Lumbar Fusion Outcomes 2011, SPINE Vol 36, Number 4, pp320-331) demonstrated that 2 years after fusion surgery, 26% of fusion cases had RTW while 67% of nonsurgical had RTW within 2 years from the date of injury. You are so right Joe, education is a powerful tool in preventing a poor outcome and motivating a claimant to work harder towards non-invasive functional restoration.
States and insurers should also address the self referral problem of surgeons using imaging centers and surgery centers where they own shares, or equipment. Actually oncology groups also own imaging equipment and over utilize it also, in my opinion. These practices must cost insurers including Medicare billions per year.