Board member of the American Society of Interventional Pain Physicians
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(HealthNewsDigest.com) – In his address to Congress last Wednesday, President Obama espoused a government-run insurance plan. Politicians and many of the American public have voiced concern that this piece of legislation will instigate rationing of healthcare benefits and services. Knowingly, the president touched on that issue. He said that he will “make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care you need”.
The pledge stimulated heavy applause among attendees. However, it inspired a polar response in me, because it’s not consistent with what I already see being proposed by Medicare today: namely, cuts and reduced access to care.
Let’s consider a prime example. Noridian recently proposed to physicians a pending determination for non-coverage of facet joint interventions, a standard and commonly accepted form of pain treatment that has been proven effective. If the non-coverage policy is implemented, lumbar facet procedure reimbursements will be denied for Medicare patients in Alaska, Oregon, Washington, Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming.
This is an alarming example of trying to eliminate coverage rather than address the fundamental problems of waste and inefficiency. This policy strongly suggests that there will be broad implications for the health care system if public coverage decisions nationwide are to be administered by the government
The ruling will likely eventually be applied nationwide and will cause millions of chronic pain patients to go without basic, medically accepted treatments.
Measures like Noridian’s, which threaten to make interventions extinct, will perpetuate misdiagnosis, over testing, ineffective therapies, a greater reliance on narcotics and the need for more spinal surgeries, ultimately contributing to escalating health care costs.
The Current Procedural Terminology (CPT) codes in question are sometimes overused and/or misused, often fraudulently, by improperly trained physicians who lack specific expertise within the field of Interventional Pain Management. More rigorous selection criteria, and appropriate coverage guidelines for Medicare and private insurers rather than elimination of treatments, is the more appropriate response and solution.
The 2008 report from U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) stated that 63% of facet joint injection services allowed by Medicare in 2006 did not meet Medicare program requirements, resulting in approximately $96 million in improper payments. Additionally, the report illustrated that 35% of Medicare facet joint injections were performed by non-interventional pain physicians. Some specialties had a 100% billing/reporting rate according to the OIG report.
The Noridian case is part of a growing trend. As a physician who specializes in the diagnosis and treatment of spine pain on a daily basis, I find it inconceivable that this procedure, which has proven diagnostic and therapeutic value, would be removed from coverage to the detriment of Medicare beneficiaries. This is an incorrect and inappropriate response to the problem that is occurring in this country and does not get to the root of the problem.
President Obama made it expressly clear in his speech that if Americans aren’t able to find affordable coverage, then the government will provide them with a choice. Unfortunately, there will be no real choice if the government is deciding which treatments Americans can do with and without.
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