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Medicare Provider partially funds study on back pain device, yet Still Calls treatment investigational and experimental! Why?

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A prospective study of 296 patients recruited between 2002 and 2005, and supported in part by a grant from Independence Blue Cross, a Medicare provider, was recently published in the February 2008 issue of Archives of Physical Medicine and Rehabilitation. The authors of the study titled, “Outcomes after a Prone Lumbar Traction Protocol for Patients with Activity-Limiting Low Back Pain: A Prospective Case Series Study” found that, “Patients reported significantly improved pain and RMDQ [Roland-Morris Disability Questionnaire] scores after 16 to 24 visits of prone traction at discharge, and at 30 days and 180 days discharge.” On average pain intensity decreased from a score of 5.8 at preintervention to a score of 3.7 at discharge. The authors go on to state that, “Arguments can be made that if outcomes after prone traction using the VAX-D are superior to those after conventional traction or other equivalent interventions, investing in and reimbursing for traction provided by the VAX-D system may be cost effective.” Although the pain reduction data in this study represents a lower percentage than recent data published on a competitive supine device, it does indicate, “…the likelihood that these measures reflected clinically detectable improvement.” Yet, regardless of this positive outcome, the study clearly states that, “Independence Blue Cross does not endorse any findings from this study.” In fact, per Independence Blue Cross’s current medical policy number 07.08.01b, they consider this treatment modality to be, “experimental/investigational.” To review this policy go to:

http://medpolicy.ibx.com/policies/mpi.nsf/e94faffabc7b0da68525695e0068df65/85256aa800623d7a8525725e006b0727!OpenDocument



This is not the first time that Blue Cross has demonstrated that its medical reimbursement polices are inconsistent. On September 3, 2007 Alice Dembner of the Boston Globe reported on the controversy surrounding the innovative surgical procedure vertebroplasty. In her article, Ms. Dembner writes,



“Although Medicare pays for the procedures in most of the country, Blue Cross Blue Shield, Massachusetts’ largest private insurer does not. The Blue Cross decision is based on a 2005 analysis that found there was not enough evidence to show that vertebroplasty was effective and beneficial. An expert committee convened by Medicare the same year also found evidence lacking, but committee members were convinced that both procedures would eventually be determined to work better than basic treatment for reducing pain and improving mobility. Last year, Medicare spent more than $600 million on the procedures. “If we stopped paying for everything that had no evidence of benefit, we would be a very unpopular organization, “said Dr. Steve Phurrough, director of Medicare’s coverage and analysis group. “Back pain is an increasing problem in our country and people … want something done.”



To view this article visit:

http://www.boston.com/news/globe/health_science/articles/2007/09/03/spine_tuning/