05.13.14
With spinal fusion surgeries receiving extensive scrutiny from various facets of the U.S. medical community, the number of procedures performed will be hindered by reimbursement changes, according to an analyst with United Kingdom-based research and consulting firm GlobalData.
Joseph Gregory, GlobalData’s analyst covering surgical devices, says that a wide variety of stakeholders, from health insurers and hospital management to spine surgeons and policy makers, has expressed concerns that the increasing procedure volumes in this market may not always be associated with medically necessary indications.
Based on information from the Agency for Healthcare Research and Quality, the number of spinal fusion procedures in the United States annually has increased by 77 percent from approximately 260,000 in 2002 to 460,000 in 2011. Gregory said that this growth rate appears much more dramatic when compared with the surgical repair of other orthopedic degenerative conditions in differing articulations.
“One of the primary reasons for this rapid growth is expansion in the indications for which spinal fusion surgery is performed," he said. "The original intent of spinal fusion was to treat severe scoliosis and spinal tuberculosis, but its indication profile has since increased significantly. Now there are 14 conditions for which the procedure is deemed medically indicated, including degenerative disc disease and stenosis.”
The use of spinal fusion in an increasing number of indications and its associated cost to the healthcare system has led to significant changes in the reimbursement policies for this procedure in the United States, according to Gregory.
“Insurance companies have recently instituted several measures to combat these soaring figures," he said. "Originally, insurers issued reimbursement payments as long as the hospital coded the procedure properly. “Now, the payers require extensive documentation to validate the medical necessity of the procedure, including well-documented attempts at conservative care and radiographic imaging to record the source of pain.”
GlobalData analysts believe that such measures will tamper with the spinal fusion procedural growth rate and subsequently impact the overall market valuation over the coming years. While these procedures have experienced compound annual growth rates of close to 10 percent in the past, this rate is expected to be reduced to 5 percent throughout the forecast period until 2020.
Joseph Gregory, GlobalData’s analyst covering surgical devices, says that a wide variety of stakeholders, from health insurers and hospital management to spine surgeons and policy makers, has expressed concerns that the increasing procedure volumes in this market may not always be associated with medically necessary indications.
Based on information from the Agency for Healthcare Research and Quality, the number of spinal fusion procedures in the United States annually has increased by 77 percent from approximately 260,000 in 2002 to 460,000 in 2011. Gregory said that this growth rate appears much more dramatic when compared with the surgical repair of other orthopedic degenerative conditions in differing articulations.
“One of the primary reasons for this rapid growth is expansion in the indications for which spinal fusion surgery is performed," he said. "The original intent of spinal fusion was to treat severe scoliosis and spinal tuberculosis, but its indication profile has since increased significantly. Now there are 14 conditions for which the procedure is deemed medically indicated, including degenerative disc disease and stenosis.”
The use of spinal fusion in an increasing number of indications and its associated cost to the healthcare system has led to significant changes in the reimbursement policies for this procedure in the United States, according to Gregory.
“Insurance companies have recently instituted several measures to combat these soaring figures," he said. "Originally, insurers issued reimbursement payments as long as the hospital coded the procedure properly. “Now, the payers require extensive documentation to validate the medical necessity of the procedure, including well-documented attempts at conservative care and radiographic imaging to record the source of pain.”
GlobalData analysts believe that such measures will tamper with the spinal fusion procedural growth rate and subsequently impact the overall market valuation over the coming years. While these procedures have experienced compound annual growth rates of close to 10 percent in the past, this rate is expected to be reduced to 5 percent throughout the forecast period until 2020.