Dear ISASS Members:

It has been brought to my attention that YOUR IMMEDIATE ACTION IS REQUIRED regarding a time sensitive notice issued by the Agency of Healthcare Research and Quality (AHRQ). Summarized, AHRQ has requested comments on spinal fusion for painful lumbar degenerative disc or joint diseases. It is our timely duty, and it is imperative that we respond with a strong front supporting the care of our spinal patients. As spinal surgeons, we must be actively involved in this worthy endeavor.

I STRONGLY ENCOURAGE YOUR ACTION. ISASS will forward a statement with the ISASS Lumbar Fusion Policy Statement. I plan to formulate my own testimonial this week in both written and YouTube format. I implore each of you to act as well – every spinal surgeon member should send any support letter, article, case experience, and/or testimonial available to AHRQ.

The deadline for comments is 11:59pm on February 21, 2012. Visit this link to submit your comments:

AHRQ: Comments on Key Questions

AHRQ wants to understand whether the use of spinal fusion in the treatment of adults with low back pain caused by degenerative disc disease (DDD), lumbar stenosis, or degenerative spondylolisthesis:

• offers acceptable peri-operative outcomes (i.e., surgery time, blood loss, length of stay);
• has a sustainable impact on patients’ function, quality of life, or pain reduction; and
• affords patients clinical benefits that outweigh the potential adverse events associated with its use.

Following completion of the comment period, AHRQ may elect to pursue development of a formal technology assessment or other review document that can be used by CMS or other health insurance payers to inform coverage determinations. Given AHRQ’s description of the evidence, including conclusions drawn from the 2006 Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), it appears that any analysis performed will pre-suppose that limited published evidence exists to demonstrate the safety and clinical efficacy of spinal fusion in the lumbar spine.

AHRQ’s summary of the issues references the November 30, 2006 Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) review of this topic. AHRQ notes that the MEDCAC members “lacked confidence in published evidence of pain relief efficacy and safety, and found its informativeness for patient selection is unclear.” Additionally, the panel found that “identified studies had inconsistent findings regarding efficacy when compared to nonsurgical treatment, enrolled heterogeneous patient populations, and had design and execution limitations.” The problem, AHRQ notes, is that more recent evidence following this 2006 MEDCAC has not provided any firmer conclusions as to the safety and efficacy of this treatment option.

A potential negative assessment published by AHRQ, following the comment and review period, could negatively impact coverage for lumbar fusion procedures. As they have done historically, CMS and commercial health plans can utilize AHRQ assessments to inform their own coverage determinations.

Our society, ISASS, will forward comments, along with our:

Policy Statement on Lumbar Fusion Surgery

To review AHRQ’s call for comments, along with the questions they pose, please see:

AHRQ: Comments on Key Questions

Again, the deadline for comments is 11:59pm on Tuesday, February 21st.

I urge you all to stand up for your profession and the patients we serve.

Thank you,

Morgan Lorio, MD
Chair, ISASS Coding & Reimbursement Task Force