More Medicare patients are having complex back surgery even when there’s often an easier, less risky and less costly fix, according to a study in the Journal of the American Medical Association. The rate of complex fusion surgery for spinal stenosis, which causes lower back pain, increased 15-fold from 2002 to 2007, according to the study.
The study and an accompanying editorial suggest that aggressive marketing by implant makers, and greater physician compensation for high-tech procedures, may be influencing treatment. Meanwhile, taxpayers bear the expense, and patients face increased risks. From the JAMA editorial:
The proliferation of risky and expensive practice beyond reasonable supporting evidence is commonly mentioned as a fundamental failing of medical practice in the United States. Although it is unclear why this phenomenon occurs in many areas, conflicting economic incentives are clearly at work in spinal surgery. Just as simpler interventions in other clinical fields usually have no sponsor beyond the conscientious and compassionate clinician, simple decompression operations rarely have well-funded advertising campaigns or well-orchestrated promotions at professional meetings.
… the findings from the study by Deyo et al should not only remind patients, surgeons, and payors that the efficacy of basic spinal techniques must be assessed carefully against the plethora of unproven but financially attractive alternatives, but also should serve as an important reminder that as currently configured, financial incentives and market forces do not favor this careful assessment before technologiesare widely adopted.
Read more about the study in the Associated Press.
