The North American Spine Society announced 13 new coverage policy recommendations to assist payers, providers and patients with information to help determine which types of services and procedures should be covered for payment and to improve patient access to evidence-based spine care.
The new recommendations, which were announced in a press release, resulted from a review of available clinical evidence by the North American Spine Society (NASS) Board of Directors.
“Maintaining patient access to high-quality, evidence-based and ethical spine care is the single most important part of NASS’ mission,” William Watters III, MD, MMS, MS, NASS president, stated in the press release. “It is our hope that payers, spine specialists and their patients will use these evidence-based coverage recommendations as a reference to advocate for appropriate care for patients.”
Christopher M. Bono
“The need was clear. Within the structure of NASS, we have had a committee that is solely dedicated to responding to insurance companies when they ask for feedback on their proposed coverage policies. More often than not, their coverage policies were short-sided, offered incomplete or incorrect rationale for coverage, and had overly restrictive policies that were not based on the best evidence.”
Christopher M. Bono, MD, who chairs the NASS Coverage Task Force, told Spine Surgery Today. “NASS believed we could move efforts upstream and develop our own coverage recommendation that insurance could use a priori in determining coverage. One of the number one issues for spine care providers in the U.S. right now is denial of coverage of reasonable procedures. This was our way of taking this issue head-on.”
Improved care for patients
Bono said the new recommendations will improve care in that they clearly outline the criteria by which spine procedures should be covered. They are based on the best available evidence in addition to what most would consider to be reasonable practice, he noted.
“The most important message that NASS would like to get across in regards to the coverage documents is they have been developed without bias or agenda. They are solely intended to improve patient care and access to that care,” Bono told Spine Surgery Today.
Coverage policy recommendations are now available for the following spine treatments:
- Cervical artificial disc replacement
- Endoscopic discectomy
- Interspinous device without fusion
- Interspinous fixation with fusion
- Laser spine surgery
- Lumbar artificial disc replacement
- Lumbar discectomy
- Lumbar fusion
- Lumbar laminotomy
- Lumbar spinal injections
- Percutaneous thoracolumbar stabilization
- Recombinant human bone morphogenetic protein (rhBMP-2)
Bono told Spine Surgery Today the coverage documents are easy to read and follow. The average spine care provider or insurance company representative can readily follow the coverage recommendations in order to make a determination if a procedure or test should be covered.
Promotion is key
Many members of NASS expressed interest in joining the Coverage Task Force to develop the recommendations, Bono said. The task force includes representatives from multiple specialties, including physiatry, anesthesiology, neurosurgery, radiology and orthopedic surgery. Volunteers had to have been trained in evidence-based medicine.
“The next step is promotion. We want insurance companies, spine care providers, patients and any other interested parties to use these coverage documents. Our plan is to make sure we get the word out as much as possible. Most immediately, we will be reaching out to the top 10 to 15 health insurance providers in the U.S. to inform them of what we have produced and explore how they can utilize our coverage recommendations as a resource in developing their policies. All the while, we have more coverage documents to develop in the coming months,” Bono said. – by Robert Linnehan
For more information:
Christopher M. Bono, MD, can be reached at the Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02478; email: email@example.com.
Disclosure: Bono has a position with NASS. He is also a consultant for United Health Care and receives a stipend for a deputy editor role for the Journal of the American Academy of Orthopaedic Surgeons. He receives royalties from Wolterks Kluwer for edited books.