How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? A population-based comparison of workers' compensation systems

Spine Journal

Volumn 14, Issue 7, 2014, Pages 1237-1246

  Martin, Brook I ^a   Franklin, Gary M ^b   Deyo, Richard A ^c   Wickizer, Thomas M ^d   Lurie, Jonathan D ^a   Mirza, Sohail K ^a  

^a DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE   (United States)

^b WASHINGTON STATE DEPARTMENT OF LABOR AND INDUSTRIES   (United States)

^c OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

^d OHIO STATE UNIVERSITY   (United States)

Author keywords

Coverage and reimbursement; Degenerative disease; Lumbar spine fusion; Readmission; Safety and quality; Workers' compensation

Indexed keywords

BONE MORPHOGENETIC PROTEIN;

ADULT; ARTICLE; BACKACHE; CONFIDENCE INTERVAL; DATA BASE; DEGENERATIVE DISEASE; FEMALE; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE UTILIZATION; HOSPITAL COST; HOSPITAL READMISSION; HUMAN; INTERVERTEBRAL DISK HERNIA; LUMBAR SPINAL STENOSIS; LUMBAR SPINE; MAJOR CLINICAL STUDY; MALE; MEDICAL DEVICE COMPLICATION; OUTCOME ASSESSMENT; POSTOPERATIVE COMPLICATION; PRIORITY JOURNAL; RADIODIAGNOSIS; REGRESSION ANALYSIS; REIMBURSEMENT; REOPERATION; RISK FACTOR; SAFETY; SPINE FUSION; SPINE SURGERY; SPONDYLOLISTHESIS; SURGICAL TECHNIQUE; TREATMENT OUTCOME; UNITED STATES; WORKMAN COMPENSATION; WOUND COMPLICATION; ADVERSE EFFECTS; AGED; CALIFORNIA; CLINICAL PRACTICE; ECONOMICS; INSURANCE; INTERVERTEBRAL DISC DEGENERATION; INTERVERTEBRAL DISC DISPLACEMENT; LUMBAR VERTEBRA; MIDDLE AGED; PROCEDURES; SPINAL STENOSIS; WASHINGTON; YOUNG ADULT;

ADULT; AGED; CALIFORNIA; FEMALE; HOSPITAL COSTS; HUMANS; INSURANCE COVERAGE; INTERVERTEBRAL DISC DEGENERATION; INTERVERTEBRAL DISC DISPLACEMENT; LUMBAR VERTEBRAE; MALE; MIDDLE AGED; OUTCOME ASSESSMENT (HEALTH CARE); PATIENT READMISSION; PRACTICE PATTERNS, PHYSICIANS'; REOPERATION; SPINAL FUSION; SPINAL STENOSIS; SPONDYLOLISTHESIS; WASHINGTON; WORKERS' COMPENSATION; YOUNG ADULT;

EID: 84902655980     PISSN: 15299430     EISSN: 18781632     Source Type: Journal    
DOI: 10.1016/j.spinee.2013.08.018     Document Type: Article

References (45)

1. R.A. Deyo, D.T. Gray, and W. Kreuter et al. United States trends in lumbar fusion surgery for degenerative conditions Spine 30 2005 1441 1447
2. Corporate medical policy lumbar spine fusion surgery. Blue Cross Blue Shield of North Carolina. 11/2011. Available at: http://www.bcbsnc.com/assets/ services/public/pdfs/medicalpolicy/lumber-spine-fusion-surgery.pdf. Accessed February 1, 2012.
3. K. Elam, V. Taylor, and M.A. Ciol et al. Impact of a worker's compensation practice guideline on lumbar spine fusion in Washington State Med Care 35 1997 417 424
4. I. Harris, J. Mulford, and M. Solomon et al. Association between compensation status and outcome after surgery: a meta-analysis JAMA 293 2005 1644 1652
5. S. Maghout-Juratli, G.M. Franklin, and S.K. Mirza et al. Lumbar fusion outcomes in Washington State workers' compensation Spine 31 2006 2715 2723
6. W.C. Watters III, C.M. Bono, and T.J. Gilbert et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis Spine J 9 2009 609 614
7. R. Chou, J. Baisden, and E.J. Carrajee et al. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline Spine 34 2009 1094 1109
8. J.S. Fischgrund, M. Mackay, and H.N. Herkowitz et al. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation Spine 22 1997 2807 2812
9. H.N. Herkowitz, and L.T. Kurz Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis J Bone Joint Surg Am 73 1991 802 808
10. S.K. Mirza, and R.A. Deyo Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain Spine 32 2007 816 823
11. R.A. Deyo, and S.K. Mirza The case for restraint in spinal surgery: does quality management have a role to play? Eur Spine J 18 2009 331 337
12. Washington State Health Care Authority. Health Technology Assessment Program. Findings and coverage of lumbar fusion & discography. 2007. Available at: http://www.hta.hca.wa.gov/lumbar.html. Accessed February, 1, 2012.
13. J.N. Weinstein, T.D. Tosteson, and J.D. Lurie Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial JAMA 296 2006 2441 2450
14. J.N. Weinstein, T.D. Tosteson, and J.D. Lurie Surgical versus nonsurgical therapy for lumbar spinal stenosis N Engl J Med 358 2008 794 810
15. V. Vamvanij, B.E. Fredrickson, and J.M. Thorpe et al. Surgical treatment of internal disc disruption: an outcome study of four fusion techniques J Spinal Disord 11 1998 375 382
16. B.I. Martin, S.K. Mirza, and B.A. Comstock et al. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures Spine 32 2007 382 387
17. R.A. Deyo, S.K. Mirza, and B.I. Martin et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults JAMA 303 2010 1259 1265
18. G.M. Franklin, J. Haug, and N.J. Heyer et al. Outcome of lumbar fusion in Washington State workers' compensation Spine 19 1994 1897 1904
19. Office of the Medical Director, Washington State Department of Labor & Industries. Surgical guidelines for lumbar fusion (Arthrodesis), 2009. Available at: http://www.lni.wa.gov/ClaimsIns/Providers/TreatingPatients/ ByCondition/lumbarfusionarthrodesis.asp. Accessed February 1, 2012.
20. California Department of Industrial Relations, Division of Workers Compensation. Spinal Surgery Second Opinion Procedure. Title 8 California Code of Regulations, Section 9788.01, 2004. Available at: https://www.dir.ca.gov/dwc/ . Accessed February 1, 2012.
21. P.A. Lindsey, and J.P. Newhouse The cost and value of second surgical opinion programs: a critical review of the literature J Health Polit Policy Law 15 1990 543 570
22. B.O. Wynn, and G. Bergamo Working paper: payment for hardware used in complex spinal procedures under California's official medical fee schedule for injured workers 2005 RAND Institute for Civil Justice and Health Available at: https://www.dir.ca.gov/dwc/ Accessed February 1, 2012
23. T.J. Errico, R.J. Gatchel, and J. Schofferman et al. A fair and balanced view of spine fusion surgery Spine J 4 2004 S129 S138
24. R.A. Deyo, A. Nachemson, and S.K. Mirza Spinal-fusion surgery - the case for restraint N Engl J Med 350 2004 722 726
25. State Inpatient Databases (SID). Healthcare cost and utilization project (HCUP) Agency for Healthcare Research and Quality, 2010. Available at: www.hcup-us.ahrq.gov/sidoverview.jsp. Accessed February 1, 2012.
26. K.S. Cahill, J.H. Chi, and A. Day et al. Prevalence, complications, and hospital charges associated with use of bone-morphogenetic proteins in spinal fusion procedures JAMA 302 2009 58 66
27. D.T. Gray, R.A. Deyo, and W. Kreuter et al. Population-based trends in volumes and rates of ambulatory lumbar spine surgery Spine 31 2006 1957 1964
28. J.A. Cowan, J.B. Dimick, and R. Wainess et al. Changes in the utilization of spinal fusion in the United States Neurosurgery 59 2006 15 20
29. B.J. Williams, J.S. Smith, and K.M. Fu et al. Does bone morphogenetic protein increase the incidence of perioperative complications in spinal fusion? A comparison of 55,862 cases of spinal fusion with and without bone morphogenetic protein Spine 36 2011 1685 1691
30. Centers for Disease Control and Prevention. International Classification of Diseases, Ninth Revision, Clinical Modification. 2010. Available at: http://www.cdc.gov/nchs/icd/icd9cm.htm. Accessed February 1, 2012.
31. R.A. Deyo, B.I. Martin, and W. Kretuer et al. Revision surgery following operations for lumbar stenosis J Bone Joint Surg Am 93 2011 1979 1986
32. M. Shiloach, S.K. Frencher, and J.E. Steeger et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program J Am Coll Surg 210 2010 6 16
33. National Committee for Quality Assurance. HEDIS 2012 Volume2: Technical Specifications. Available at: http://www.ncqa.org/HEDISQualityMeasurement/ HEDISMeasures/HEDIS2012.aspx. Accessed February 1, 2012.
34. Medicare Payment Advisory Commission. Payment policies for inpatient readmissions. Report to Congress: promoting greater efficiency in medicine. 2007. Available at: http://www.medpac.gov/documents/jun07-entirereport.pdf. Accessed February 1, 2012.
35. S.F. Jencks, M.V. Williams, and E.A. Coleman Rehospitalizations among patients in the Medicare fee-for-service program N Engl J Med 360 2009 1418 1428
36. D. Remus, and I. Fraser Guidance for using the AHRQ quality indicators for hospital-level public reporting or payment 2004 Department of Health and Human Services, Agency for Healthcare Research and Quality AHRQ Pub 04-0086-EF. Available at: http://www.qualityindicators.ahrq.gov/Downloads/News/ AHRQ%20QI%20Guide%20to%20Comparative%20Reporting%20v10.pdf Accessed February 1, 2012
37. H. Quan, V. Sundararajan, and P. Halfon et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data Med Care 43 2005 1130 1139
38. D.L. Miglioretti, and P.J. Heagerty Marginal modeling of nonnested multilevel data using standard software Am J Epidemiol 165 2007 453 463
39. B.I. Martin, S.K. Mirza, and G.M. Franklin et al. Hospital and surgeon variation in complications and repeat surgery following incident lumbar fusion for common degenerative diagnoses Health Serv Res 48 2013 1 25
40. H.E. Jones, and D.J. Spiegelhalter The identification of "unusual" health-care providers from a hierarchical model Am Stat 65 2011 154 162
41. U.S. Bureau of Labor Statistics. Consumer price index calculator. Available at: http://www.bls.gov/cpi/. Accessed February 1, 2012.
42. S.K. Mirza Folly of FDA-approval studies for bone morphogenetic protein Spine J 11 2011 495 499
43. R.A. Deyo, A. Ching, and L. Matsen et al. Use of bone morphogenetic proteins in spinal fusion surgery for older adults with lumbar stenosis: trends, complications, repeat surgery, and charges Spine 37 2012 222 230
44. A.G. Lawthers, E.P. McCarthy, and R.B. Davis et al. Identification of in-hospital complication from claims data. Is it valid? Med Care 38 2000 785 795
45. U.S. Census Bureau. Current population survey, 2012. Available at: http://www.census.gov/. Accessed February 1, 2012.