Biloine W. Young, Orthopedics This Week
HealthPartners, the largest consumer-governed, nonprofit health care organization in the United States, has notified its members who are considering back surgery that they must first be evaluated by a physician who will focus on nonsurgical options before they can see a surgeon.
In a story first reported by the Minneapolis Star Tribune writer Jackie Crosby on January 5, Health Partners officials said the change in policy came about because of growing evidence that aggressive treatments may not always be the most effective treatment for low-back pain. They project that patients will be willing to choose treatments, other than surgery, once they receive information about the options available to them.
HealthPartners has identified 102 sites in Minnesota and Wisconsin where patients with back pain can meet with specialists in rehabilitation, occupational medicine and sports medicine.
“They are not the gatekeepers,” insisted Dr. Thomas Marr, HealthPartners’ medical director of clinical relations, who was quoted in the newspaper story. “Patients can still see a surgeon if they wish. But after this visit, they’ll be better informed about all of their options, and can make decisions more aligned with their own values.”
HealthPartners paid out more than $28.3 million on lumbar fusions and other spine surgeries in 2011. Had this new program, of first seeing a specialist for back pain before consulting a surgeon, been in place in 2010, about 8,800 out of the 1.36 million enrolled in HealthPartners insurance plans would have been eligible for the evaluations.
Surgeries dropped by 26 percent and orders for high-tech radiology fell by 12% after implementation. HealthPartners has been examining its treatment costs and patient outcomes associated with low-back pain since 2004.
HealthPartners is the top-ranked health plan in Minnesota for the seventh consecutive year and is the among the top 25 plans in the nation for the third consecutive year, according to the National Committee for Quality Assurance’s Health Insurance Plan Rankings 2011-12.
Source: Orthopedics This Week, January17, 2012