Uncounted are procedures by private insurers, and uninsured surgeries. Any idea how to estimate those figures? Noted is the potential for confusion, errors and miscellaneous errors in billing. Information is included of the benefits experienced by three patients. Four doctors are scrutinized. Of the 480,000 spinal fusions performed annually, it would be helpful for more extensive follow-up on a larger sample of patients. Are some lives better, some worse and some unchanged? On April 6, 2015 a number of news stories appeared about the Journal of the American Medical Association study about an increase in back surgeries.
[From article]
The attorney also objected to the use of billing codes to count spinal fusions for "degenerative" conditions that cause lower back pain. "It is simply not possible to discern the diagnosis(es) from the CPT code alone," she wrote.
It is true that the billing codes describe a technique - not a diagnosis. Some widely accepted fusions are billed for using these same codes. But while the data does not reveal whether any of the fusions that a doctor performed were inappropriate, experts say high numbers raise questions and serve as starting points for further investigation.
[. . .]
When we looked into Dr. Jimenez, we found that in 2006 he was suspended indefinitely by a network of five hospitals in Georgia. According to a confidential report obtained by CBS News, it concluded that he "pose[d] a threat to the life, health and safety of patients." There were concerns about, among other things, his "surgical competency and selection of procedures." Dr. Jimenez eventually left the hospital system and sued it for racial discrimination. He claimed the review committee made up lies to oust him and did not give him a hearing. The case was eventually dismissed.
[. . .]
Keith is now suing Dr. Alexander for allegedly aligning her neck crookedly and performing a more aggressive surgery than necessary. She has virtually no movement of her head, and it is stuck in a tilted position looking down and off to the right. Multiple doctors have said a corrective surgery would involve removing rods and screws that Dr. Alexander put in and entail significant risk. The case is ongoing.
Kimberly Keith's x-ray after surgery
Hilliard Munoz Gonzales LLP
[. . .]
Dr. Resnick added that Medicare, medical societies, and credentialing bodies (including state medical boards and the American Board of Medical Specialties) should use databases like the one in this story to follow practice patterns and patient outcomes. He said surgeons with the highest numbers should be closely looked at and asked to explain themselves. But he said that won't happen without a source of funding, as the work is time consuming and entails legal risk.
[. . .]
More than 480,000 spinal fusions are performed in U.S hospitals each year, making them more common than even hip replacements. The annual cost of these surgeries is more than $12 billion, according to the Agency for Healthcare Research and Quality. Experts disagree about how many may be unnecessary, but Dr. Richard Deyo, a critic of the procedure and professor at Oregon Health and Science University believes it could be as much as half. For Medicare and Medicaid patients, taxpayers foot the bill.
http://www.cbsnews.com/news/tapping-into-controversial-back-surgeries/
By Ben Eisler
CBS News
April 24, 2014, 6:30 AM
Tapping into controversial back surgeries
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