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Economic Burden*
Spine and musculoskeletal disorders account for nearly 70 million physician
visits in the United States each year, and an estimated 130 million outpatient,
hospital and emergency room visits. In 2003, nearly 1.3 million people took
time away from work to be treated and recover from work-related musculoskeletal
pain or impairment of function in the lower back or upper extremities. According
to U.S. census data, 80% of all adults experience back pain at some time in
their lives. For one in ten people, back pain is a chronic problem and represents
the second leading cause of hospital admissions in the United States.
Conservative estimates of the economic burden imposed by these disorders, as
measured by compensation costs, lost wages and lost productivity, are between
$45 and $54 billion annually. Moreover, statistics reveal that a person who
remains out of the work force for up to six months due to a back injury has
a less than a 50% probability rate of ever returning to work; after twelve months,
the rate drops to less than 12%; and after two or more years, the rate decreases
to less than 1%.
It has also been found that in a large percentage of persons who have undergone
multiple surgeries, performed by one or more spine surgeons, a greater degree
of Failed Back Surgery Syndrome and long-term disability. This particular diagnosis
prevails as the leading condition for work-related injuries. Both employers
and workers are demanding alternative, innovative and effective methods for
medical management of spinal conditions.
It is this scenario of widespread back and neck problems, the resultant economic
drain and disappointing treatment results which indicates that current methods
of delivering spine care are less than optimal. The ability to quickly restore
function, reduce pain and decrease costs of care are the greatest challenges
facing the field of spinal treatment today.
*California Workers' Compensation Institute Proceedings, June 2003, U.S. Labor
Department, US Department of Health and Human Resources, 2003.
Economic Pressures for Surgeons
Spine surgeons too, have felt the economic pressures. Prior to the 1990’s, the
traditional practice of medicine allowed hospitals, specialists and outpatient
facilities to offer a variety of specialized programs and treatment resources
under the premise that “if you build it, they will come.” Managed care, and
the move away from the utilization of specialists in favor of primary care physicians,
brought about major changes in the way care was delivered.
Today’s healthcare delivery system mandates that specialists must not only
provide appropriate quality care, but also be cognizant of methodologies or
technologies that promote cost effectiveness and/or minimally invasive modalities.
In today’s healthcare climate, spine specialists must “partner” with their facility
to insure that adequate levels of reimbursement/profit are secured for professional,
technical and instrumentation fees. Therefore, spine specialists must participate
in a paradigm of healthcare delivery that promotes accountability, savings and
state-of-the-art care.
Competition Among Specialties
Currently, various healthcare disciplines are vying for the spine care patient
market. This competitive environment has often estranged specialists and minimized
cooperation and opportunities for multi-disciplinary management of spinal conditions.
Solving this specialty fragmentation represents a unique opportunity to improve
spine care by reducing expenses and avoiding the duplication of studies and
unwarranted procedures.
Resistance to Early Referral
Another challenge to effective spine care has been the resistance of “urgent”
and/or primary care physicians to early, aggressive, pro-active specialty intervention.
By providing primary care physicians with outcomes proven treatment protocols,
their willingness to refer patients appropriately for care improves, and patients
can be moved to the most effective site of care quickly.
There has never been a more opportune time for spine, neurosurgical, orthopedic,
and pain specialists to unite under an integrated delivery system for the delivery
of state-of-the-art operative and non-operative spine care.
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