News & Information
Spinal Fusion Costs Spur Insurance Changes
Written by Editor   
Tuesday, July 08, 2014 07:20 AM

Over the past two decades, the search for relief from back pain led skyrocketing numbers of Americans to a costly procedure that bonds vertebrae together. But as evidence mounted that spinal fusion surgery was used too often for the wrong people, insurer Cigna decided in 2011 to see how its own members had fared.  The news was startling: 87 percent of customers who had spinal fusion to treat pain due to wear and tear on spinal discs were still in so much pain two years later that they needed more therapies or drugs. Nearly 15 percent had more surgery. Total cost of the post-surgery claims: $11 million. That's on top of the initial fusion surgeries, which can carry price tags of $100,000 each, though insurers don't pay that much.

There is a growing number of private insurers that limit the circumstances in which they'll pay for spinal fusions. In part because of this trend, the phenomenal growth in spinal fusions — a case study in the debate over runaway health costs — should slow down, according to a report last month from London-based industry analyst GlobalData.

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California Medical Doctors Used Fake Hardware in Spine Surgeries Lawsuits Say
Written by Editor   
Monday, July 07, 2014 05:33 PM

Medical Doctors in Southern California have implanted counterfeit screws and rods, ginned up in a small machine shop, into the backs of thousands of injured workers, according to lawsuits filed throughout the state.  Some doctors who used the bogus hardware took kickbacks including cash and private plane rides, while middlemen and hospitals profited by wildly inflating the cost of the screws, according to one suit filed in Sacramento.

The allegations deepen the scandal surrounding a Corona del Mar hospital executive who pleaded guilty in April to paying doctors to bring in patients as part of a $500 million insurance scam.  The executive, Michael Drobot, also admitted to bribing former state Sen. Ronald Calderon to keep huge insurance payments flowing.

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A Broken Market in Antibiotics
Written by Editor   
Monday, July 07, 2014 04:53 PM

The drugs don't work - and neither does the market, when it comes to antibiotics.

When sophisticated bugs that medicines used to kill within days start to fight back and win, all of healthcare, and the people it keeps alive, is in trouble.

It's a glimpse of what Britain's chief medical officer Sally Davies calls the "apocalyptic scenario" of a post-antibiotic era, which the World Health Organisation says will be upon us this century unless something drastic is done.

Waking up to the threat, governments and health officials are getting serious about trying to neutralize it. It may seem like a question of science, microbes and drugs - but in truth it is a global issue of economics and national security.

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Novitas Reports New Medicare Reimbursement Fee Schedule
Written by Editor   
Wednesday, July 02, 2014 11:42 AM

Novitas Solutions reports its new fee schedule for 98940, 98941, and 98942.  The Excel spreadsheet file may be downloaded here:  New Reimbursement for 98940, 98941, and 98942 Effective 7/1/14

Click on the image below to see the image.  Click again to zoom in.

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Opioid, Heroin Deaths Continue to Climb
Written by Editor   
Wednesday, July 02, 2014 09:52 AM

Overdose deaths from both prescription opioids and heroin continued to rise in 2011, the most recent year for which data were available, according to the CDC.

While prescription opioid deaths followed a more than decade-long trend and increased about 2% to 16,917, heroin deaths jumped by 44% -- from 3,036 in 2010 to 4,397.

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