Insurers are increasingly scrutinizing spinal fusion procedures and putting up new hurdles that could curtail the category’s growth.
The St. Paul Pioneer Press reported over the weekend that the number of spinal fusion procedures performed in Minnesota fell off slightly in 2009 after a decade of fast growth. Meanwhile, sales of Medtronic (NYSE:MDT) spinal products plateaued between 2009 and 2010 after years of increases.
Health plans and a growing number of doctors think too many patients are getting lumbar fusions without first exhausting less expensive non-surgical options such as exercise, physical therapy and epidural steroid injections.
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Blue Cross Blue Shield of North Carolina issued new rules last month that require surgeons to get prior review and approval from the insurance company before they will cover the procedures. And Twin Cities-based HealthPartners started requiring patients to review booklets or videos about treatment alternatives before allowing the procedure.
Medtronic is responding by ramping up its marketing efforts, hoping to create new clinical and economic evidence to support the products.
