Spinal Fusions driven by Doctor Finances?

Doctors with financial interest in spinal fusion surgery may be more apt to recommend it, according to a government study report on the billing of 1,000 Medicare patients. (See the Washington Post story)

The Office of Inspector General of the Department of Health and Human Services focused the report on the spread of companies owned by physicians who profit from the high-dollar  hardware used in spinal fusions. The price of equipment alone – plates, rods and screws – can top $11,000 for a single fusion.

The study showed that six months after a hospital began to purchase spinal devices from a doctor-owned distributorship, spinal fusion surgeries jumped an average of 21 percent, more than double that of other hospitals.

At a moment in time when President Obama’s healthcare plan is taking heat from both parties and putting healthcare at the top of the news, Senator Orrin Hatch (R-Utah) claimed this study shows a “direct correlation between the perverse financial incentives created by physician-owned distributorships and the rise in these highly invasive spinal surgeries.”

A special fraud alert in March 2013 by the Office of Inspector General found the distributorships “inherently suspect,” language which has led to a lawsuit filed by one such distributorship.

California lawyer Matthew Umhofer represents a doctor-owned distributorship that has sued the Office of Inspector General for finding the outfits “inherently suspect.” Umhofer disputes the idea that these distributorships drive doctors to perform surgery.

In Umhofer’s view, hospitals may attract more spinal fusion surgery after they start buying from a doctor-owned distributorship because more surgeons want to work at the hospital.

Umhofer asks whether a distributorship can move “an otherwise honest doctor in the direction of unnecessary surgery?”

Another factor is whether physician-owned distributorships can explain a spinal fusion increase which somewhat predates the increase in physician-owned distributorships. Spinal fusion surgeries rose more than fourfold, from 98,000 in 1996 to 465,000 in 2011, which makes it even more difficult to discern the real impact of doctor-owned distributorships in the rise of spinal fusions.

It will likely become even more difficult to separate the doctors’ financial interests from their recommendations to perform spinal fusions as more and more of them acquire distributorships, which is the trend.

Many reasons, meanwhile, might help explain the boom in spinal fusion surgeries in spite of the growing distributorships, including the aging population and improved surgical techniques that would seem to invite more and more surgeons to perform spinal fusions.

But spinal fusion critics have noted the distributorships’ economic incentives for surgeons. The Washington Post also reported in October that, “based on an analysis of 125,000 patient records, roughly half the large increase in spinal fusions in Florida involved patients with diagnoses that many experts and professional societies say should not routinely be treated with spinal fusion.”

Simple decompression, for example, a much less radical alternative to spinal fusion, can often offer as much benefit as fusion while posing fewer risks. A decompression might earn a surgeon around $1,000 in parts, while a fusion could put as much as $6,000 in the pocket.

Those with a back problem visiting a doctor might be wise to ask whether their doctor also owns a distributorship before opting for a fusion. Back surgery and back care is a serious matter for everyone; so it would probably be worthwhile to gather all the knowledge available, including the doctor’s financial ties, before deciding on a treatment option.

Matthews & Associates law firm is handling InFuse case for people across the country hurt by InFuse during spinal fusion and other types of spine surgeries.  If you or someone you love has experienced problems following spinal fusion surgery, email us for a free legal consultation or call 888-520-5202.

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