Indeed, some now question the efficacy of a variety of expensive spinal fusion surgeries that are invasive, cause a higher rate of infections, require longer recovery time and often do not resolve pain after two years any more than if the patient were given medications and physical therapy.
Bach and Pearson acknowledge that changing Medicare's approach to coverage and reimbursement could require even more legislation and authority. And it would, they wrote, "be highly contested by those with a vested interest in existing reimbursement systems."
But they are guardedly optimistic for four reasons:
1. Medicare's ballooning costs must be tempered.
2. The idea of paying equally for comparable results resonates with patients and policymakers.
3. State Medicaid programs and private insurers could be first adopters with lessons learned from smaller scale approaches.
4. Such a policy may not need legislative overhaul at all, but might be woven into the regulatory process.
During our chat this week, Bach conveyed his frustration with what the authors described today's "perverse" system of payment incentives.
"What new technologies do we want disseminated if the justification for disseminating them is just that they get a higher reimbursement rate?" he asked. "To us, a higher reimbursement should come with greater effectiveness, not 'just because....' "