Medicare Reconsiders Paying For Seniors’ Spine Operations At Surgery Centers

Medicare is reviewing whether seniors should undergo spine surgeries at same-day surgery centers, the government-run health program announced Wednesday, five months after a USA Today Network-Kaiser Health News investigation revealed a spate of patient deaths following the procedures.

The proposal states that Medicare officials will examine whether these procedures “pose a significant safety risk” to patients and continue to “meet the criteria” for Medicare payment.

The news investigation found that in 2021 and in 2021 Medicare approved same-day spine operations for seniors even though at least 14 patients had died since 2008 after such procedures.

Some suffocated from the well-known complication of upper-spine surgery that may generally be reversed if caught immediately and treated properly.

The investigation also found that some medical professionals urging Medicare to pay for surgery centers to operate on seniors' spines didn't mention recent incidents of death in their own or an affiliated facility.

Dr. Nancy Epstein, a chief of neurosurgical and spine education at Ny University Winthrop Hospital, lauded the proposal, saying patients face extensive risks after spine surgery.

“It's about time,” Epstein said of the review proposal, which she expects to rankle some doctors who've a financial stake inside a spine surgery center.

Bill Prentice, executive director from the Ambulatory Surgery Center Association, addressing the centers in policymaking discussions, said he supports Medicare stepping up its efforts to do an internal and external overview of the procedures its smart for at surgery centers.

“The more resources they use, the better,” Prentice said. “I believe that the greater data points they have, the more likely they are to help make the right decision. – We feel these procedures can be carried out very safely within the ambulatory surgery center space.”

Medicare announced the plan to re-evaluate its decision to cover seniors' spine procedures in a yearly rule-making document released Wednesday. The company is accepting comments on the proposed changes through Sept. 24 and is likely to release a final decision late around.

The proposal to examine the security of spinal measures in seniors is on-page 441 of the document. Individuals who would like to comment can do so here.

The nation's 5,600-plus Medicare-certified surgery centers are required to have an internal governing body that decides which surgeries it will perform around the center's patients. However, the federal agency decides which operations it will pay for in surgery centers, continuously proposing and adding some procedures during annual rule-making.

The recent proposal aims to review 38 procedures added since 2021, of which 25 involve spine surgery, and make a continuing intend to continually review approved procedures. The proposal says that because “Medicare beneficiaries are usually frailer and exhibit a higher quantity of comorbidities than other populations, we believe it might be appropriate to reevaluate recently-added procedures.”

The proposal also says Medicare uses “all available data,” “prevailing medical practice” and any public comments it receives to evaluate whether to keep paying for the procedures.

The USA Today-KHN investigation, involving reporters based in California, Indiana, Florida and Nj, included a review of thousands of pages of lawsuits, state records and Medicare's own inspection reports. It found that spinal surgery patients suffered tragic complications in surgery centers or soon after they left.

The cases incorporate a Florida man, then 53, whose doctors left soon after an upper-spine surgery. Soon afterward, he had breathlessness. A nurse called 911, and paramedics who rushed to the surgery center initially hit a locked door, the household's lawsuit says. The man remains inside a vegetative state.

A California woman, Paulina Tam, 56, told a nurse she was having problems breathing after her upper-spine surgery, a Medicare inspection report says. Her medical team had also left during the day. A doctor who happened to be in the center after 6 p.m. later told a situation inspector he “wasn't prepared” to do an urgent situation surgery to insert an airway with the front of her throat. Tam died the next morning.

Her son, Dr. Eric Tam, a brand new York City physician, said Medicare's proposal is “overall very good news – someone is looking into something a minimum of.”

However, he explained one worry about your time and effort is the fact that “I'm not necessarily sure just how much data they need to examine.”

Health databases for a lot of under-65 patients will make it difficult to link injuries which happen following a patient leaves a surgery center. Your research found court public records showing that some upper-spine surgery patients developed fatal complications your day they left a surgery center.

They include a San Diego man whose wife said he gasped “like a fish” awaiting an ambulance after his surgery in 2021, a Dallas man who collapsed in his father's arms in a similar scenario this year and a Portland man who pounded the roof of the car as his wife sped towards the hospital.

None of these survived.

In emails sent this past year, Medicare officials said when they approved similar spine surgeries for seniors, they didn't get any public comments the procedures would put patients at risk.

Dr. Tony Asher, director of the national neurosurgery quality and outcomes database who is additionally a surgery center association board member, acknowledged that he was “appalled” by a few cases in news reports investigation.

He said spine surgeons have to embrace more transparency on safety outcomes associated with specific procedures – and particular surgery centers.

“In an optimal setting, it is possible to do these things effectively and safely,” he said. “On a continuing basis, we have to show we're providing that.”