The Radiological Society is urging several commercial insurers to realign their payment policies to align key procedures with Medicare.
On May 1, medical groups from nearly 10 countries expressed concern. letter Humana, Etna, etc. Their dissatisfaction stems from policies regarding the coverage of minimally invasive surgery to treat vertebral compression fractures.
The American College of Radiology, along with similar groups representing neuro, spine, and interventional radiologists, criticized payers’ policies prohibiting coverage for such surgeries in the first few days after a fracture.
“Limiting surgical procedures to fractures older than 6 weeks of age can adversely affect patient outcomes and the ability of providers to provide appropriate, evidence-based spinal care to all patients. We believe it should be fixed/removed,” said the ACR et al. I have written. “In particular, the recent literature supports this proposal by positively impacting patient biomechanical changes, pain scores, quality of life, mortality, and long-term economic benefits. “
May 5th news post, the university estimates that “at least” six private insurers currently require four to six weeks of conservative management before a patient undergoes percutaneous spinal augmentation. Conflicts with medical literature and Medicare payment policies in effect after 2021. Delayed surgical management in an often frail and elderly patient population can lead to prolonged immobility, immobility, and drug use, which can lead to poor physical condition. Decreased lung function and increased risk of death.
Insurers in this initiative also include Cohere Health, Evicore, Health Care Services Corp. and Aim Specialty Health. The latter has already replied to the letter and is “considering the matter,” the ACR reported Friday.
Meanwhile, other medical groups participating in the campaign are the American Academy of Pain Medicine, the American College of Anesthesiologists, and the North American Spine Society.
