To Be or Not To Be?

Seems like a few of our readers are struggling with insomnia and have become a bit antagonistic over this entire vertebroplasty/kyphoplasty issue.  Insomnia is not suffering.  Many industry professionals have come to recognized that your identity is imposed upon you by your job, and by your possessions, finally you realize that you are not in control  of your life.  Unfortunately, proponents of VCFx have had to defend the efficacy of these procedures the last year.  It was reported on 10/18 that a growing number of third party payers are reconsidering their coverage of VCFx procedures.    Dr. Christopher Bono reported that at least three insurers have issued draft policies that would end reimbursement payments for VCFx procedures, and in some cases kyphoplasty.

Noridian Administrative Services, LLC manages Medicare payments for 11 Western states.  An LCD, aka a local coverage decision was issued in May of this year, and physicians and companies had through September 6 to submit comments to the coverage decision.  Noridian is now writing its final policy which should be ready sometime around the first quarter in 2011.  This coverage could be terminated, or Noridian may adopt provisions on when it thinks the procedures are appropriate and worth covering.

Dr. Bono believes that Noridian's decision carries a lot of weight with other insurers, so, this could potentially have a cascading effect with other carriers.  Surgeons and companies are concerned that this decision could impact the number of procedures, as the majority of these patients are the elderly.    The recently published AAOS guidelines, and, the study in the NEJM have set off a maelstrom effect in the industry whereas proponents of vertebral augmentation (kyphoplasty) have distanced themselves from vertebroplasty procedures.  But the question must be posed to our readers, does augmentation actually restore the height of the fractures vertebral body?  Or, is this procedure designed to eliminate pain, restore some functionality, and potentially lower the cost of care?  Noridian's argument is that there is an absence in the literature that demonstrates the efficacy of either vertebroplasty or kyphoplasty.

The question must be asked, is there a pattern of overuse and misuse of this procedure?  Are IR's and surgeons injecting cement into too many levels  resulting in a disturbing amount of post-op complications?  Many surgeons and IR have risen to the defense of these procedures, yet, they concede that there must be stricter guidelines.  Interestingly enough the two groups commented that they take the misuse of these procedures seriously, yet, the question must then be asked, how do you police yourselves?

A touchy subject?  Of course it is.  Considering that companies like CareFusion, Stryker and ArthroCare are in the process of releasing new lines, no wonder some of our readers are struggling with insomnia and are a bit antagonistic.   One must consider William Shakepeare's opening line of the soliloquy in Hamlet; "To be or not to be, that is the question, Whether 'tis nobler in the mind to suffer the slings and arrows of outrageous fortune, or to take arms against a sea of trouble, And by opposing, end them.  TSB wants to know what will be the outcome?