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No Incentive Seen for Avoiding Isolated Decompression

Reimbursement is actually lower for combined decompression and instrumented fusion

THURSDAY, Aug. 7 (HealthDay News) -- Contrary to some reports, there is not an undue financial incentive for spine surgeons to recommend a combined decompression and instrumented fusion procedure instead of an isolated decompression in patients with symptomatic lumbar degeneration, according to a report published in the August issue of the Journal of Spinal Disorders & Techniques.

Peter G. Whang, M.D., of the Yale University School of Medicine in New Haven, Conn., and colleagues compared 50 single-level decompression cases performed by a single surgeon and 50 single-level decompression and instrumented posterolateral fusion with autogenous iliac crest bone grafting cases.

Compared to the decompression group, the researchers found that mean surgical time and total clinical time expenditure was significantly longer in the combined-procedure group (134.6 minutes versus 47.3 minutes, and 186.6 minutes versus 62.2 minutes, respectively). Yet they found that the compensation -- in mean dollars received per minute of surgeon time -- was significantly lower for the combined procedure ($12.51 versus $15.51).

"In this era of escalating medical costs and diminishing resources, it is obviously naive to maintain that economic factors do not play a critical role in the delivery of health care," the authors conclude. "Regardless of the myriad challenges that confront physicians of all specialties on a daily basis, with few exceptions we maintain that most of spine surgeons still strive to adhere to the ideal standards set forth in the Hippocratic oath and willingly accept their responsibility to their patients above all else."

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