On April 28, outgoing SAS president Karin Büttner-Janz, M.D., Ph.D. turned over a spine society that has grown in size, identity and global scope to incoming president Chun-Kun Park, M.D.
Büttner-Janz also hands off the SAS presidency to Park at a time of great challenge and opportunity for spine surgeons. Economic pressures continue to mount and more evidence of clinical and cost-effectiveness is being demanded by public and private payers.
With a new set of bylaws (crafted with the contributed wisdom of the spine industry’s Ben Franklin, Charlie Ray, M.D.), the Spine Arthroplasty Society is no more and will forever be known as SAS: The International Society for the Advancement of Spine Surgery. This renewed focus on all spinal medicine moves the organization through its adolescence into early adulthood.
The organization also broadened its global reach in 2009 as it established new Society chapters in China, India, the Middle East, and Korea. Another sign of SAS’ growing maturity in the last year was its entry into the mainstream of medical politics by joining the American Medical Association’s House of Delegates.
Consolidating the Revolution
Motion preservation of the spine is no longer a revolutionary concept, and the Society is now preparing itself for the new task of educating members about the importance of bringing the best evidence of science and cost-effectiveness of motion preservation practices to the public and private payers around the world.
In his inaugural address to members, Park said that these payers are “keen to dampen” the use of non-fusion devices by limiting the use of discs and putting a cap on coverage.
Park didn’t shy away from noting that surgeons bear some responsibility for that situation through “improvident usages of non-fusion devices, lack of interest to archive objective data, lack of educational programs for patients, and insufficient marketing strategies by industry.”
Richard Deyo, M.D.
During an interview with OTW, Park told us that educating surgeons and payers will be the hallmark of his presidency of SAS.
In his address to members, Park said, “while SAS may have crossed the Rubicon at its Miami Beach meeting in 2008, it has been stumped by Rome’s defensive walls. The most ideal situation is to pass through the wall gate without conflict and enter the city peacefully.”
What will be the vehicle that will allow that passage through the gates of reimbursement and who will be the champion to overcome the forces of “Deyoism” (spine surgery critic Richard Deyo, M.D.)?
Perhaps the answer will be SIMPLE.
S.I.M.P.L.E.
Matthew Gornet, M.D., wowed attendees at the 4th Annual Spine Technology Summit on April 27 when he reported on his study of 24 workers’ compensation patients. This study used Dr. Gornet’s SIMPLE model to measure the socioeconomic impacts of motion preservation versus fusion.
Matthew Gornet, M.D.
SIMPLE stands for Socioeconomic Impact Model with Productivity Loss Estimates.
The model, using prospective data, showed that while medical costs between lumbar disc arthroplasty (LDA) patients and fusion patients were comparable, those costs didn’t tell the whole story.
Differences in temporary total disability (TTD) between the two groups alone tell a compelling story. Patients with LDA had a median of 42 fewer weeks of TTD. The total socioeconomic impact was $286, 000 less for an LDA patient than a fusion patient.
Furthermore, workers’ comp claims for LDA patients were settled sooner and had significantly lower disability settlement awards than claims for fusion patients.
The SIMPLE model used some of the following cost metrics as its framework:
- Legal expenses, all disability payments and medical expenses from injury claim costs
- Absenteeism – wage/benefit x disability days
- Hiring/training costs
- Legal/administrative fees
- Disability impact on society – 100% of permanent disability awards
Gornet and his team are planning on submitting this study for peer review in the near future. If the SIMPLE model proves to be an accurate tool for measuring the comparative effectiveness of various medical treatments, spine may have found a champion with a sling shot.
Rallying the Troops
President Park and society leaders will have some work to do to rally their colleagues judging from the lack of attendees at the society’s business meeting and advocacy luncheon.
“Spine is under siege, ” said Gunnar Andersson, M.D., Ph.D., as he moderated a panel of coverage and reimbursement experts. According to the panel, patients are encountering impediments in accessing spine surgery as payers hear the criticisms from those who claim that there are too many surgeries, indications are weak and disc degenerative disease is just a normal process of aging and isn’t that painful.
His panel walked through the byzantine process of CPT codes and RUC evaluations. Panel members said that SAS has not been at the table as have other medical societies which have worked to favor their procedures at the expense of SAS surgeons.
We asked Mike Bebee, a Washington, D.C.-based public policy consultant on the panel, if recent coding changes advocated by NASS (North American Spine Society) created economic incentives for surgeons to favor fusion over disc replacement. His answer was yes.
Clearly, if SAS is to accomplish its goal of becoming THE international spine society, it will have to become a rabid advocate for its members in the upcoming battle over scarce public resources.
Comparative Effectiveness
While the hope for a peaceful entry through the gates of Rome (reimbursement) and the embrace by payers of motion-preservation spine procedures and devices is laudable, some believe it won’t be peaceful and the battlefield is already being prepared in Washington, D.C. through the debate over comparative effectiveness.
President Obama put $1.1 billion into a stimulus package to establish a comparative effectiveness research institute whose job it will be to figure out ways to determine which medical treatments work best as the U.S. government tries to slow the expenditures for Medicare, Medicaid and Social Security.
Left unchecked, those three programs are expected to consume the entire federal budget within a generation. That’s not a legacy baby boomers will want to leave their children. Clearly, hard choices about rationing health care are on the horizon.
In that debate, the arguments that will determine the winners of medical treatments will be those that demonstrate the best socioeconomic value to society, patients and payers.
Comparative effectiveness is something surgeons can support, Stephen Hochschuler, M.D., told us in London. “But that data can be misinterpreted and surgeons need to take charge in offering their expert opinions in establishing the metrics of what works and what doesn’t.”
He fears that the medical societies have been too heavily influenced by non-surgeons, medical association staffs and others who do not necessarily have the physicians’ best interests in mind.
Spine Society Summit
Perhaps in an effort to unify the various medical societies focused on spine in the upcoming comparative effectiveness battle, Dr. Park told us that SAS Vice President Tom Errico, M.D., will be representing SAS in a meeting with NASS (North American Spine Society), AANS (American Association of Neurological Surgeons), CRS (Scoliosis Research Society), and CNS (Congress of Neurological Surgeons) in September in Chicago.
Some of the topics expected to be discussed at the meeting include:
- Ethical and Productive Industry Relationships
- Sunshine Act
- Department of Justice and Spine
- Research Funding
- “Prove it or lose it”
- Outcome Registry
- Fellowships
- 3rd Party Administration of Industry Funds
- Resisting the Continuous Erosion of Reimbursement
- Public Awareness
These five societies have already established a precedent for working together on the comparative effectiveness issue.
Last fall all five societies signed a letter to CMS commenting on the relative value and reimbursement rates of kyphoplasty and vertebroplasty. In that letter the societies expressed an unprecedented opinion that the more expensive kyphoplasty procedure offered no additional benefit over the less expensive vertebroplasty procedure and recommended equal reimbursement rates for both procedures.
If the societies will walk the transparency talk, we’ll attend the meeting and report back to our readers.
New Technology
Dr. Park concluded his inaugural remarks with the phrase, “A successful future opens its doors to those who think innovatively.”
Innovatively speaking, there was nothing revolutionary at this meeting.
Thierry Marnay, M.D., French spine philosopher and one of the original motion preservation revolutionaries, told us while walking through the exhibit hall of vendors that the revolution of innovation may well be that surgeons’ minds are now freed from the limits once assumed about the possibilities in motion preservation. The thinking is now about more and better motion preservation, not simply the concept.
He believes the most important work of spine medicine is yet to come.
Looking at the various company displays, Marnay said that he has seen the progression of companies with devices first invented by surgeons, then companies with devices invented by engineers, and now finally, companies with devices invented by marketing people. In a market economy, that’s progress.
Dr. Marnay promised to write an article for a future edition of OTW on this topic.
There were 30-some company presentations made at the Spine Tech Summit hosted by OTW’s publisher, Robin Young, and P&M Corporate Finance’s Bryan Hughes. Those showing the most promise in providing surgeons with the tools to determine appropriate patient selection, surgical procedures and devices, and imaging technologies to demonstrate clinical and cost-effectiveness for payers were the companies developing diagnostics, predictive genetic tools and imaging technologies.
MEDICREA’s C-Jaw These companies included Axial Biotech, Intrinsic Therapeutics, Ortho Kinematics, SpineGuard, and Biospace med.
Two society leaders and pioneers, Hansen Yuan, M.D., and Luiz Pimenta, M.D, pointed to first-time presenter MEDICREA’s C-JAWS, an elegantly designed cervical compression staple, as one of the most interesting new devices at the Summit.
MEDICREA’s C-JAWS is an interbody fusion staple which can replace plates and screws used to hold cages in place during cervical fusion and can reduce the one-hour procedure surgery time by half.
MEDICREA’s new system of anterior cervical anchoring works through the plastic deformation of a titanium implant, resulting in a fixing of the mounting.
Attendance and Exhibitors
In all there were 74 booths at this year’s meeting, up from 73 in 2008 and 54 in 2007. Total attendance looked likely to surpass the 1, 471 attendees in Berlin in 2007, but fall short of the record number of 1, 868 attendees in Miami Beach in 2008.
As usual, exhibitors grumbled about traffic and location. London’s giant Excel Center swallowed the SAS meeting and the intimacy of some previous meetings was lost.
The SAS meeting in London will be remembered for the call to arms, the rise of socioeconomic evidence for motion preservation and the continued maturation of a society trying to become THE international spine society for surgeons. Recent grumbling by NASS members about new disclosure requirements and a focus on quality and excellence of spine science instead of surgeons gives SAS an opening to grab the mantle as the preeminent spine surgeon society in the world.
However, that contest will have to wait for another day as the spine troops have to join forces to storm the gates of reimbursement.
Who will be the champion to take on the forces of Deyo?
That answer might be SIMPLE. We’ll know when SAS reconvenes in New Orleans in 2010.
