MINNEAPOLIS, January 5, 2009—A Pioneer Press article describes how HealthPartners is seeking to find alternatives to expensive back surgery.

A report by Christopher Snowbeck says that HealthPartners will soon require doctors to encourage patients seeking lumbar fusion to take part in a "shared decision making" process.

The new policy heightens a national debate about the cost and quality of spine surgery.

HealthPartners already requires that surgeons seek approval before performing certain lumbar fusions.  Starting in February physicians will be required to hand out approved decision guides (booklets or videos) that describe alternatives to surgery, the pros and cons of the different approaches, and where to go for more information.

No other commercial health plan in the state requires prior authorization for spinal fusions, although the state requires such authorization for certain public health insurance programs.

Fusion surgeries cost Medicare $482 million in 2003 — a jump of more than 500 percent from $75 million the year before.

Doctors at Twin Cities Spine Center in Minneapolis told the Pioneer Press that they understand the need to address costs. Surgeons also see that there is wide variation in the number of fusions surgeons perform nationwide.

Even so, the article said, prior authorization policies will cause resistance if they attempt to boil considered medical judgment down to a too-simple yes-or-no authorization form.

Complete Pioneer Press story