All surgery comes with risks, but some seem to have more risks than others – and lower success rates.
Surgeons have been billing Medicare and private health insurers for hundreds of spinal fusion procedures that were either unnecessary – or weren’t completed at all, a review has found. And the success rate was low.
The discovery was made in 2018 in a review conducted by spinal surgeon Dr Roy Carey on behalf of health insurance company Bupa. The report is receiving more attention now as a result of the joint ABC-Sydney Morning Herald-The Age investigation into Medicare fraud.
A spinal fusion operation is one of the most expensive spinal surgeries offered in Australia and can cost as much as $50,000. It’s also deemed to be the riskiest spine surgery in terms of patient outcomes.
Read: Doctors estimate $8 billion a year lost to Medicare fraud
Out of 1200 private health insurance spinal fusion claims he reviewed, Dr Carey concluded more than 85 per cent had been incorrectly billed by using incorrect Medicare item numbers.
He also examined 300 spinal fusion claims through WorkSafe Victoria and found 293 had been inappropriately billed.
“[There were] things that were plainly impossible – like billing for services that were not possible, given the nature of the operation described,” Dr Carey told the Sydney Morning Herald.
“For example, correction of a scoliosis when none was present, or removal of part of a vertebrae which would be contra-indicated given the operation described.”
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Changes were made to the Medicare Benefits Schedule (MBS) after the review. They aimed to give doctors more specific Medicare item numbers in a bid to drive down unnecessary claims.
Dr Carey says it’s hard to know how many spinal fusion surgeries are being performed today, but that the new system did seem to be working better.
“Anecdotally, it seems more difficult to game,” he says.
In addition to incorrect billing for spinal fusion, but there is growing evidence that spinal fusion surgery is not producing the outcomes expected.
Read: Plagued by low back pain? This study is for you
A University of New South Wales (UNSW) study examined almost 10,000 patients who had spinal fusion surgeries between 2010 and 2018.
They found the surgeries were unsuccessful more often than not, and in some cases left previously healthy people unable to work.
Only 19 per cent of patients returned to work within two years and nearly one in five needed additional spine surgery within two years – including some patients who required up to five additional surgeries.
Have you had spinal fusion surgery? Was it effective in treating your back pain? Let us know in the comments section below.
I have had spinal fusions Cervical Spine C3 – C6, this is the loss of 3 discs,
and Lumber spine L5-S1.
Without these fusions 20 years ago I would be a quadriplegic.
Since these fusions I live a pretty normal life with very little pain.
Without them life would be excruciating.