London, UK – With spinal fusion surgeries receiving extensive scrutiny from various facets of the US medical community, the number of procedures performed will be hindered mainly by reimbursement changes, says an analyst with research and consulting firm GlobalData.
Joseph Gregory, GlobalData’s Analyst covering Surgical Devices, states that everyone, 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 US annually has increased by 77%, from approximately 260,000 in 2002 to 460,000 in 2011. Gregory says that this growth rate appears much more dramatic when compared with the surgical repair of other orthopedic degenerative conditions in differing articulations.
The analyst continues: “One of the primary reasons for this rapid growth is expansion in the indications for which spinal fusion surgery is performed. 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 utilization 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 US, according to Gregory.
The analyst says: “Insurance companies have recently instituted several measures to combat these soaring figures. 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 believes that these 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% in the past, this rate is expected to be reduced to 5% throughout the forecast period until 2020.