URGENT: Washington State HTA to consider elimination of spinal injection coverage

[lobelsteve]

Has anybody noticed this?

http://www.hca.wa.gov/assets/program/lumbar_fusion-rr_final_findings_decision_012016[1].pdf

Looks like they're not just picking on IPM. They also reviewed cervical fusion in 2013.

The stance of the population health advocates is, if nothing works much better than placebo, pick the treatment that is cheapest, lowest risk, and will lead to good patient satisfaction scores.

For private practice doctors not in Texas or other physician friendly states, I would start transitioning to boutique practice/cash pay, ASAP.

Deny fusion for DDD. They allow for severe stenosis and radiculopathy. Still room to clamp down further.

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[Ducttape]

The stance of the population health advocates is, if nothing works much better than placebo, pick the treatment that is cheapest, lowest risk, and will lead to good patient satisfaction scores.

so....
this seems so obvious - am I missing something? should these advocates recommend expensive wasteful treatments that have the potential to cause severe injury?

 

[drusso]

Has anybody noticed this?

http://www.hca.wa.gov/assets/program/lumbar_fusion-rr_final_findings_decision_012016[1].pdf

Looks like they're not just picking on IPM. They also reviewed cervical fusion in 2013.

The stance of the population health advocates is, if nothing works much better than placebo, pick the treatment that is cheapest, lowest risk, and will lead to good patient satisfaction scores.

For private practice doctors not in Texas or other physician friendly states, I would start transitioning to boutique practice/cash pay, ASAP.

Typical "race to the bottom." The Libs love this stuff. The health care system is cleaving into public/third-party and private spheres. Where do you want to be?

 

[Disciple]

so....
this seems so obvious - am I missing something? should these advocates recommend expensive wasteful treatments that have the potential to cause severe injury?

I actually wouldn't have a problem with it, except that the same groups simultaneously push other equally ineffective treatments.

It's the mixing of health policy with political agendas that's troubling.

 

[DrCommonSense]

I think that every pain and spine physician owes Paul Dreyfuss and his crew a sincere debt of gratitude--not just for advocacy in WA state but for over 20 years of service in our field in all domains:

WA State Advocacy:

Advised Regence on medial branch blocks, facet joint injections and medial branch RF neurotomy which was instrumental in subsequent policy edits 2011

Advised Premera on C2-3 facet RF neurotomy and sacroiliac joint injections, lateral branch blocks and lateral branch RF neurotomy which was instrumental in subsequent policy edits 2014

Served as WA state expert on cervical and lumbar radiofrequency neurotomy to review and comment on preliminary and final evidence review by SPECTRUM. Also, testified at HTCC meeting in defense of coverage for RF neurotomy by summarizing errors in SPECTRUM's report and providing key evidence in defense of RF neurotomy 2014

Provided public comment to WA HCA/HTCCon Spine Injections 2010

Provided public comment to WA HCA/HTCC on Radiofrequency Neurotomy for facet pain 2014

From his formative involvement in PASSOR to his leadership in SIS-Health Policy and the MPW, he is an important role model showing how physicians can push-back against psuedo-scientific meta-analysis and population-based mumbo-jumbo to advance the best pain care for our patients.

I am reading his analysis online from the WA HTA assessment and its TRULY remarkably well done.

He is easily showing the bias in Chou's research by only selecting poorly designed RCTs (many which didn't use fluoroscopic techniques) while ignoring many other RCTs that weren't sufficiently "double blinded" that showed very good results.

Chou's analysis through the AHRQ was also very biased in the fact that most other HTA criteria used to determine efficacy of procedures/meds (viscosupps, cochlear implants, proton beam usage for CA research, etc) often included non blinded RCTs and prospective observational studies to win them the statement of "efficacy".

Chou purposely attempts to downplay comparative effective research as well despite Cochrane analyses using these for valid scientific proof of efficacy.

I really think Chou is just paid off by big pharma and others to push this garbage.

 

[bedrock]

I am reading his analysis online from the WA HTA assessment and its TRULY remarkably well done.

He is easily showing the bias in Chou's research by only selecting poorly designed RCTs (many which didn't use fluoroscopic techniques) while ignoring many other RCTs that weren't sufficiently "double blinded" that showed very good results.

Chou's analysis through the AHRQ was also very biased in the fact that most other HTA criteria used to determine efficacy of procedures/meds (viscosupps, cochlear implants, proton beam usage for CA research, etc) often included non blinded RCTs and prospective observational studies to win them the statement of "efficacy".

Chou purposely attempts to downplay comparative effective research as well despite Cochrane analyses using these for valid scientific proof of efficacy.

I really think Chou is just paid off by big pharma and others to push this garbage.

Agree that Chou is morally corrupt POS, whose opinions mean nothing.

 

[Stim4me]

Agree that Chou is morally corrupt POS, whose opinions mean nothing.

It's rigged.... who's behind it? NIH? CMS? Advisory medical board? Obama-jk?

 

[DrCommonSense]

It's rigged.... who's behind it? NIH? CMS? Advisory medical board? Obama-jk?

I think Chou wants to just eliminate stuff to show "he's doing something" to increase his consultant fees with for profit groups like Spectrum whose sole purpose is to "cut spending" at the expense of patients/physicians.

These guys are literal parasites on the system who increase "efficiency" by literally cutting down case while taking the FEES and BONUSES as a result.

These parasites never cause the cost of healthcare to decrease overall, they just move the money to themselves and cronies.

For instance, look at Washington State Medicaid which has eliminated Kypho, Knee Arthroscopy, SCS, etc. You would figure that since so many treatments aren't offered for the Medicaid population, the total costs of Washington State for Medicaid should be the lowest in the nation, considering they basically cover the least in the nation right?

WRONG, Washington Medicaid expenditures per capita are not better than most of the Southern States that cover all these procedures. http://kff.org/medicaid/issue-brief/medicaid-per-enrollee-spending-variation-across-states/

What gives right? Where's the cost savings again?

 

[Stim4me]

I think Chou wants to just eliminate stuff to show "he's doing something" to increase his consultant fees with for profit groups like Spectrum whose sole purpose is to "cut spending" at the expense of patients/physicians.

These guys are literal parasites on the system who increase "efficiency" by literally cutting down case while taking the FEES and BONUSES as a result.

These parasites never cause the cost of healthcare to decrease overall, they just move the money to themselves and cronies.

For instance, look at Washington State Medicaid which has eliminated Kypho, Knee Arthroscopy, SCS, etc. You would figure that since so many treatments aren't offered for the Medicaid population, the total costs of Washington State for Medicaid should be the lowest in the nation, considering they basically cover the least in the nation right?

WRONG, Washington Medicaid expenditures per capita are not better than most of the Southern States that cover all these procedures. http://kff.org/medicaid/issue-brief/medicaid-per-enrollee-spending-variation-across-states/

What gives right? Where's the cost savings again?

I believe some of his studies are NIH funded. Government has also funded studies to dilute pain medicine expenditures to mid levels

 

[drusso]

I think Chou wants to just eliminate stuff to show "he's doing something" to increase his consultant fees with for profit groups like Spectrum whose sole purpose is to "cut spending" at the expense of patients/physicians.

These guys are literal parasites on the system who increase "efficiency" by literally cutting down case while taking the FEES and BONUSES as a result.

These parasites never cause the cost of healthcare to decrease overall, they just move the money to themselves and cronies.

For instance, look at Washington State Medicaid which has eliminated Kypho, Knee Arthroscopy, SCS, etc. You would figure that since so many treatments aren't offered for the Medicaid population, the total costs of Washington State for Medicaid should be the lowest in the nation, considering they basically cover the least in the nation right?

WRONG, Washington Medicaid expenditures per capita are not better than most of the Southern States that cover all these procedures. http://kff.org/medicaid/issue-brief/medicaid-per-enrollee-spending-variation-across-states/

What gives right? Where's the cost savings again?

Below is a good commentary about the liability of interpreting data in the absence of expertise. It applies to the recent Presidential election, but could just as easily apply to GIGO science/meta-analysis:

https://www.linkedin.com/pulse/with...e-david-sable?trk=hp-feed-article-title-share