GEOGRAPHY INFLUENCES TREATMENT OPTIONS
August 2, 2005
In the past decade, the rate of back surgery among Medicare patients has increased by more than half, driven by factors including new technology to fuse damaged vertebrae, more advanced imaging to diagnose injury, generous federal reimbursements and greater demand, according to the Washington Post.
Yet even as the numbers swell, there is no clear-cut science for treating back pain. Some doctors favor surgery, while others recommend exercise, rehabilitation and other conservative approaches.
The result is a jigsaw pattern of medical care in which the patient's chance of having surgery often is decided by where he or she happens to live, says the Post:
- In Fort Myers, Fla., Medicare patients are twice as likely to have back surgery as those in Miami.
- Had Fort Myers's surgeons operated at the more conservative Miami rate, there would have been 4,800 fewer back surgeries from 1992 to 2001 and Medicare would have saved millions of dollars, according to James N. Weinstein (Dartmouth Medical School.)
- Medicare patients in Fort Myers underwent spine surgery at a rate of 6.9 per 1,000 in 2001 -- the latest year for which figures were available; in Miami, the rate was 3.2; nationally, it was 4.5.
Back surgery is a growing cost to Medicare. In 2003, the government paid about $1.6 billion to hospitals for more than 167,353 spine procedures, not including doctors' fees. The average charge per surgery was $40,000.
Dartmouth College researchers estimate that as much as one in three dollars spent by Medicare goes to unnecessary care. In that sense, variations in back surgery in South Florida provide a glimpse of Medicare's inefficiencies.
Weinstein points to what is called the "surgical signature" of doctors -- idiosyncratic patterns in the likelihood of a doctor choosing to operate. The greater the scientific uncertainty in treatment options, he says, the more variations appear.
Source: Gilbert M. Gaul, "When Geography Influences Treatment Options: Physicians in Some Regions Are More Likely to Advise Surgery Over Less-Invasive Alternatives," Washington Post, July 24, 2005.
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