THE MENU OF OPTIONS TO TREAT back pain is extensive, but whether all the methods work—or are even necessary—is the bigger
question. Meanwhile, health plans are giving more attention to back pain through targeted programs to help reduce the billions
of dollars spent in direct medical costs.
Back pain is the third most-expensive condition for plans, behind cancer and heart disease, according to Alere. Part of that
expense relates to what many say are unnecessary back surgeries, not to mention imaging studies and tests of questionable
value.
Surprisingly, back pain is usually not a disabling or a chronic condition, according to Alere research. In fact, 80% of people
in the United States will have back pain at one point or another, but only a small number have what is clinically recognized
as chronic pain. These cases usually have very high costs and high disability.
One significant high cost is the productivity lost among workers with back pain. At $28 billion, it's nearly two times the
actual direct medical costs to employers and health plans ($15 billion). Lumbar injuries translate to roughly $149 million
in lost workdays annually. From 1997 to 2005, spine-related expenses jumped 65%, more than overall health expenses. Yet outcomes for those with back
pain do not seem to have improved dramatically. In 2005, Americans spent $85.9 billion on back pain relief—surgery, physicians'
visits, MRI scans and medications—up from $52.1 billion in 1997, showed a study in the Journal of the American Medical Association's February 13 edition.
A study assessed the potential for overtreatment for back pain in six WellPoint-affiliated health plans over 12 months. It
reviewed medical and pharmacy claims data for 172,377 members in six states. The research showed unnecessary surgery was performed
in the first six weeks after diagnosis in less than 1% of patients (nearly 1,000 patients).
John Barron, the director of research opportunities at HealthCore, WellPoint's outcomes research subsidiary, says that among
the surgery patients, total costs over a six-week period added up to $18 million.
"In terms of the sheer volume, it's not many people, but they're costing a lot over a short period," Barron says. He also
found that the vast majority of the pain resolved in a relatively short period of time, often within six weeks.
"For most people with no evidence of red-flag conditions, such as cancer, trauma and neurological damage, be conservative,"
he says. "Don't be aggressive with imaging and unnecessary tests in most patients."
Further WellPoint study findings concluded more than 35,000 had unnecessary imaging tests.
NCQA GUIDELINES
National guidelines have shown that of those patients experiencing back pain, many undergo imaging tests and surgeries far
sooner than recommended. The National Committee on Quality Assurance (NCQA) has a back-pain recognition program and offers
treatment guidelines, which were used in the WellPoint study. NCQA programs also have shown most episodes of back pain resolve
in six weeks.
Meanwhile, health plans and affiliated organizations are making strides in offering customized programs to pinpoint back pain
without automatically resorting to unnecessary procedures. Alere's back-pain program for employers and MCOs focuses on pain
management, patient education and psychosocial aspects, according to Dennis Richling, MD, Alere senior vice president of product
management and former president of the Midwest Business Group on Health.
The Musculoskeletal and Pain Program is designed to parallel clinical guidelines from American Pain Society and others, for
pain management. Benefits include: reduced costs by recognizing early at-risk employees and educating them on managing pain;
reducing costs from direct medical use; reducing unnecessary diagnostic testing; and shared decision making with physician/participant.
