Medicare data cast spotlight on most prolific spinal surgeons

Experts have long been alarmed by the growth rate of spinal-fusion surgeries. Now, an analysis of new Medicare data by CBS News shows that a disproportionate number of the most risky and highest-paying procedures are being performed by a small group of high-volume spinal surgeons.

Under Medicare payment rules, the riskiest surgeries are also paid the most because they involve fusing more vertebrae together. The analysis found that just 5% of all spinal surgeons performed 40% of Medicare surgical cases that fused four or more spinal bones.

There are many potential explanations as to why some doctors recommend the highest-paying, yet riskiest surgeries far more often than do their peers. It could be that high-volume spine surgeons benefit from referrals, or simply that their clinical judgment is different.

But the CBS report noted that spinal-fusion surgery pays about five times more than less-risky alternatives, raising the question of whether some doctors are letting financial considerations influence their recommendations. A University of Wisconsin expert interviewed by the network said the data may show some doctors are “operating outside of the generally agreed upon … parameters” for spinal surgery.

A March 24 cover story in Modern Healthcare reported that widespread concern about overuse of spinal procedures has led some hospitals and health plans to rethink how they provide spine care. One hospital featured in the article now requires beneficiaries in its self-insured health plan to get intensive pre-surgical assessments before elective spinal fusions, including meeting with physical therapists and psychologists.

There were more than 465,000 spinal-fusion operations in the U.S. in 2011, compared with 252,400 in 2001, according to the Agency for Healthcare Research and Quality. The estimated cost of spinal-fusion procedures was more than $12.8 billion in 2011, according to AHRQ. Hospital costs alone for a spine procedure average $27,568 and total costs can hit six figures for major spinal-fusion procedures, experts say.

A 2011 policy statement on lumbar fusion from the International Society for the Advancement of Spine Surgery said “increasing success and optimism may be leading some surgeons to overuse procedures beyond what the current state of medical evidence really supports.” Varying spine-surgery rates suggest “a lack of collective adherence to the current state of medical evidence,” the society said.

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