Pre-op physiatry consultation reduces spinal surgery rates

John Fox, M.D., from Priority Health in Grand Rapids, Mich., and colleagues reviewed data on spine surgery rates to examine the impact of an insurer rule requiring patients with non-urgent spine surgical consultations to have a single visit with a physiatrist starting in 2007. Patients evaluated by physiatrists were surveyed to assess satisfaction.

After 2007, the researchers identified a 70 percent increase in physiatry referrals, a 48 percent decrease in surgical referrals, and a 25 percent decrease in the total number of spine operations. Total spine care costs fell by 12.1 percent and surgical costs fell by 25.1 percent. Spinal fusion increased from 55 to 63 percent of all surgical procedures, although spinal fusion rates decreased. Of the 740 patients evaluated by physiatrists, 74 percent were satisfied or very satisfied with the physiatry consultation, while only 40 percent of patients who had undergone previous spine surgery were satisfied.

"This study showed that a required physiatrist consultation for elective spine surgery radically decreased the operative rate while maintaining patient satisfaction across a large region," Fox and colleagues conclude. "Although experiences might be different in other communities, policies such as this one have the potential to improve spine care and decrease cost elsewhere."

The study was funded by Priority Health; several authors are employees of Priority Health.

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Journal reference: Spine

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