Bloomberg News reporters Peter Waldman and David Armstrong wrote an interesting expose’ on the spinal fusion industry in which they allege that spine surgeons are getting rich performing unnecessary fusion surgeries which studies show to be no more effective for common back pain than physical therapy but a lot more dangerous. Between 2002 and 2008, the number of spinal fusion surgeries in the United States doubled to 413,000, generating a whopping $34 billion in medical bills. That’s BILLION.
Waldman’s and Armstrong’s article features a Minnesota patient whose doctor diagonsed him with spinal disc degeneration, commonly treated with physical therapy, and opined that surgery was not appropriate. The patient went to a surgeon named Ensor Transfeldt at Twin Cities Spine Center in Minneapolis, which sounds like it is a fusion surgery mill, for a second opinion, and Dr. Transfeldt talked him into spinal fusion surgery in which three vertebrae in the lumbar spine were screwed together to limit motion. The surgery was a failure and the patient is now disabled and unable to hold a job. His unsuccessful surgery generated a $135,786 hospital bill.
Health care costs rose 6% last year to $2.47 trillion. The politicians and tort reform advocates who address this issue often fail to even consider the possibility that many, many surgeries in this country are unnecessary. Indeed, unnecessary surgeries cost at least $150 billion a year, according to the Center for Healthare Outcomes & Policy at the University of Michigan.
“It’s amazing how much evidence there is that fusions don’t work, yet surgeons do them anyway,” said Sohail Mirza, a spine surgeon who chairs the Department of Orthopaedics at Dartmouth Medical School in Hanover, New Hampshire. “The only one who isn’t benefitting from the equation is the patient.” So who does benefit? In the Minnesota example, the Twin Cities Spine Center bill was nearly $20,000, the hospital bill was $135,786, and Medtronics, Inc., which makes products for the spinal surgery, including Infuse, a bone-growing material used in fusions, billed $17,575. Infuse had sales of $840 million in 2009. Not coincidentally, Medtronic paid six of the 10 Twin Cities Spine Center surgeons, including Dr. Transfeldt, $1.75 million in royalties and consulting fees from January through September of 2010. It also makes other significant financial contributions to the Spine Center. So why are some doctors performing costly and risky fusion surgeries which often do nothing to relieve the patient’s back pain and may leave him or her worse off than before the surgery? Money! They can’t make millions in royalties by ordering conservative treatments like physical therapy.
Instead of grandstanding for sound bites by constantly blaming lawyers for rising health care costs, so-called tort reformers should look at the facts. The problem is the tort reformers’ and the doctors’ and medical devices manufacturers’ lobbyists are in bed together. Their goal is not to lower health care costs, but rather to have unfettered access to the kind of money discussed in the Boomberg article by hand-cuffing the lawyers who are now the last line of defense against these unscrupulous practices. Patients should be nervous when they hear tort reformers talk about government interference with a patient’s right to contract with a lawyer, limiting the right to recover for certain damages, capping recoveries, or limiting access to courts by mandating arbitration or other alternatives to the Seventh Amendment right to trial by jury.