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Surgery May Not Be The Answer To An Aching Back

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Surgery May Not Be The Answer To An Aching Back

Health Care

Surgery May Not Be The Answer To An Aching Back

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Too many people are getting risky and expensive back surgery when more minimal approaches would work. Thats according to a new study out today in the Journal of the American Medical Association. Overuse of medical care is just one of the reasons the nation's health bill is so high.

NPR's Joanne Silberner reports on the study and whether the new health overhaul law will change things.

JOANNE SILBERNER: Options for people with back pain range from physical therapy to relatively simple surgery, to extensive surgery where several vertebrae are fused together. In recent years, studies have shown that that the extensive surgery is rarely called for.

Richard Deyo of the Oregon Health and Science University and several colleagues checked Medicare data to see if doctors have been paying attention.

Mr. RICHARD DEYO (Oregon Health and Science University): What we found was the most complex type of back surgery has increased dramatically between 2002 and 2007, with a 15-fold increase.

SILBERNER: Fifteen-fold, even though there's no reason to believe there's been an increase in the number of people who need the most complex surgery, and Deyo found another problem.

Mr. DEYO: What we also found was that this more complex type of surgery is associated with substantially higher risk of life-threatening complications.

SILBERNER: Like heart attacks, strokes and blood clots. Deyo offers several possible reasons for the surgery's popularity. Some doctors may believe it works better in everyone, despite the evidence. Doctors get paid more. For the 90 minutes or so it takes to do a simple surgery to clean out the bony growth that can compress nerves, the fee is around $600 to $1,000. The fee for a five or six-hour fusion of multiple vertebrae is 10 times as high.

Eugene Carragee, professor of orthopedic surgery at Stanford University, offers one more reason.

Dr. EUGENE CARRAGEE (Professor of Orthopedic Surgery, School of Medicine, Stanford University): The marketing incentives are all going the other way.

SILBERNER: That is, manufacturers of the screws and other devices used during the complex surgery promote it heavily. So how do you get doctors and patients to pay attention to studies that show that a simpler approach works better than a more complex one?

Dr. CARRAGEE: Well, that's the $64,000 question.

SILBERNER: The new health overhaul law takes a few stabs at it. One provision gets at that marketing issue. Under the new law, payments from manufacturers to doctors to promote their products will be public information. So if a doctor has a connection to a company, you can find out. Another provision creates an institute to look at how one therapy compares to another. The law explicitly says that the institute's conclusions cannot be used to determine whether insurance will cover a procedure. Still, Carragee says, just having the information available will be a big help to doctors and patients trying to make decisions.

James Weinstein thinks so, too. He is an orthopedist from Dartmouth who did some of the original studies on back surgeries, but he says the new law on its own doesn't do enough.

Dr. JAMES WEINSTEIN (Orthopedic Surgeon; Director, Dartmouth Institute for Health Policy and Clinical Practice): Just having insurance and having a computer doesn't change health care. It puts some tools in place, but now we have to change the delivery system.

SILBERNER: That is, find a way to pay doctors and hospitals other than for each procedure. That way, they'll pay more attention to comparison studies. There are some pilot projects on that in the new law but nothing big.

Meanwhile, orthopedic surgeon Eugene Carragee suggests, for patients who are advised to get the complex spinal fusion: Make sure your doctor has a good reason for the recommendation.

Joanne Silberner, NPR News.

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