As Spinal Fusion Volume Grows, So Do Profits for Surgeons & Device Makers

Report outlines controversies over device-heavy spine procedures and surgeon-manufacturer relationships.

Are financial relationships with medical device companies and profitable reimbursement margins inducing spine surgeons to perform more fusions than necessary? A recent report in the Wall Street Journal explores several controversies associated with the growing market for these device-heavy spine surgeries. Medicare paid $343 million for spinal fusion procedures in 1997, compared to $2.24 billion in 2008 — a nearly 400% increase, according to the Journal's analysis of Medicare data. Within the medical community, doctors are divided between more conservative spine surgeons who believe fusion should be used sparingly to treat a small number of conditions, such as scoliosis, and surgeons who advocate using fusion to relieve chronic back pain or to treat degenerative disk disease, one of the most hotly debated uses of the procedure.  Blue Cross and Blue Shield of North Carolina announced earlier this year that it would stop paying for spinal fusions performed to treat aging disks beginning on Jan. 1, 2011. Nine medical associations, including the American Association of Orthopaedic Surgeons, recently sent a letter to the insurer to express concerns over the new policy and advocate for less restrictive language. One thing is certain: The increase in spinal fusions has been a boon for the companies that make and sell the hardware and implants used in spinal fusion surgery, which can cost tens of thousands of dollars for a single procedure.  Meanwhile, companies like Medtronic, the largest manufacturer of spinal implants, pay surgeons millions of dollars in royalties for their help in developing new technologies. Medtronic and the surgeons who collaborate with the company say the payments are a legitimate way for surgeons to give input on new devices and do not create a conflict of interest. Critics, including some members of Congress, argue that they are essentially kickbacks designed to boost medical device sales.  In response to this criticism, Medtronic began disclosing its payments to surgeons publicly on its website in June, and many doctors who partner with device makers say they disclose these relationships to their patients. A provision in the Affordable Care Act requires all companies to disclose such payments made to physicians by 2013. Read the full WSJ report here. Irene Tsikitas

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