Articles by JCS
Word count: 1884
Criminal Medicine: Part Two
Let There Be Light
In my previous commentary, Criminal Medicine, I mentioned the recent illegal activities of three MDs:
We know full well if chiropractors were up to their necks in this kind of fraud and malpractice, the AMA would condemn us with all its might in the media. Indeed, Sanjay Gupta @ CNN would be having a field day blasting chiropractors as dangerous greedy quacks if the shoe were on the other foot.
Of course, that $7 billion doesn’t include similar fraudulent costs from unnecessary medical care in workers’ comp programs, group health insurance, or in the TRICARE or DVA military programs. Undoubtedly, the total fraud in all these programs is staggering to imagine with spine care being the most lucrative of all medical scams.
Attorney General Loretta E. Lynch said, “This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement.”
“The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others. They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”
According to HHS-OIG Inspector General Levinson, “Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries. This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets.”
Now that the federal government seems serious about cracking down on perpetrators of unnecessary medical malfeasance, particularly “care that wasn’t needed,” the field of medical spine care should stand at the top of this hit list for investigation with the many unnecessary opioids, epidural shots, and spine fusions done annually.
Indeed, the Strike Force would have its own field day if it were to investigate the American spine industry—pain management clinics distributing addictive opioid painkillers like candy, “spine interventionalists” administering ineffective ESIs at $600 a pop, and surgeons doing spine fusions based on the disproven ‘bad disc’ diagnosis from expensive MRIs detecting ‘incidentalomas’ that also appear in pain-free people.
If this is not the foremost scam in medicine, then what is?
Let There Be Light
The list of scientific proof eschewing medical spine care is growing and the press has already exposed the spine fusion scandal over the last few years, so what more does the Strike Force need to prosecute unnecessary medical spine “care that wasn’t needed”?
Perhaps a call for transparency from the chiropractic profession would help to shine light on this medical malfeasance!
This is not a new revelation since the original 1994 AHCPR guideline clearly recommended SMT over drugs, shots, and surgery, but this has been hugely ignored by providers, press, and payors alike. Spine surgery is simply a case of too much money and too few ethics.
I liken this spine scandal to driving 55 MPH on the highway—no one follows the law until there is a cop around to enforce it. After twenty years since AHCPR, the federal cops at HHS and CMS are finally ready to bust these medical speeders out of control leaving a wake of disabled victims behind.
The call for transparency has already been touted about healthcare reform. In its January report, “Shining a Light,” the National Patient Safety Foundation defined four levels of transparency in health care:
The report called transparency the “most effective, inexpensive, and underutilized tool for improving the quality of care.”
“It’s long overdue,” said Dr. Charles Mick, former president of the North American Spine Society, who reviewed ProPublica’s findings. “Hopefully, it will be a step toward a culture where transparency and open discussion of mistakes, complications, and errors will be the norm and not something that’s hidden.”[ii]
Is this not a door opening for our profession to be in an open discussion about the abuse in medical spine care?
If the former president of NASS is willing to accept a culture of transparency and open discussion, let’s take him up on this issue with a public discussion on fusion surgery and the drawbacks of medical spine care in general—the danger of opioid addiction, the low rate of surgical success, the huge expense, and the wake of disability left behind.
In fact, this discussion began a few years ago, but never gain public or media attention, when the NASS admitted that spinal manipulation should be considered before surgery in the October, 2010, edition of The Spine Journal:
Several RCTs (random controlled trials) have been conducted to assess the efficacy of SMT (spinal manipulative therapy) for acute LBP (low back pain) using various methods. Results from most studies suggest that 5 to 10 sessions of SMT administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up. Spine care clinicians should discuss the role of SMT as a treatment option for patients with acute LBP who do not find adequate symptomatic relief with self-care and education alone.[iii]
The NASS also stated on its website:
Fusion under these conditions is usually viewed as a last resort and should be considered only after other conservative (nonsurgical) measures have failed. [iv]
The admission by NASS that fusion should be a last resort and that SMT is a first resort has been unheard by the public and ignored by spine surgeons, hospitals, and general medical practitioners.
If Dr. Mick is serious about transparency and an open discussion, he needs to hear again the statements by his organization endorsing these guidelines. Indeed, the medical inability to follow these guidelines speaks louder than the lofty words expressed by Dr. Mick or the NASS “to develop evidence-based guidelines for surgical intervention and to define conditions that are best treated without surgery.”[v]
Hear Ye, Hear Ye!
One professional way to respond to the comments from Dr. Mick and the NASS would be for our professional associations to issue a press release accepting Dr. Mick’s invitation for an open discussion on transparency.
A challenge to hold a public discussion on the issue of spine care should involve prominent surgical leaders from the NASS, CMS/HHS administrators, chiropractic leaders/researchers, media representatives, insurance groups, and patient advocacy groups to discuss openly and candidly the issues of this gross abuse, expense, and scandals in spine care and arrive at a consensus of opinion.
Holding the largest spine organization’s feet to the fire on how to improve outcomes and cut costs in spine care by following the existing guidelines in a very public forum is the way to achieve transparency and compliance.
This situation was well expressed in 2012 by David Elton, DC, and Thomas M. Kosloff, DC, co-authors of “Conservative Care: Ensuring the Right Provider for the Right Treatment”:
“Research and guidelines are consistent and clear. We don’t need another guideline, we do need to help patients receive treatment from providers aligned with research/guidelines.” [vi]
Their Optum report showed when patients encountered a chiropractor initially, the results were faster, cheaper, and more effective. Certainly, if clinical guidelines have any value to improve American healthcare in this era of healthcare reform, payors must offer chiropractic care before medical spine care as virtually every guideline now recommends for the majority of mechanical LBP cases, (excluding the ‘red flags’ of cancer, fracture, infection, cauda equina, or the one in 100 unresponsive sciatica case).
The outcome of such an invitation would be beneficial to the patients and highlight the value of conservative approaches, just as the guidelines recommend. Isn’t it time the public knew of these findings in order to make an informed decision about spine care?
If the F4CP continues with full page ads in the WSJ and other publications, perhaps one ad campaign should be the acceptance to the invitation by Dr. Mick for a public discussion on this issue.
If he and the NASS accept would be great, but if they do not the chiropractic profession will have achieved just as much benefit by the well-constructed acceptance of the challenge, and that would be a story in itself were Dr. Mick to renege. The tables would be reversed and the chiropractic profession would be seen on the right side of healthcare reform to lower costs and improve outcomes.
Certainly if Dr. Mick or the NASS were to refuse an open discussion about transparency in spine care, it would reveal the continuing mindset of the medical boycott of chiropractors that illustrates once again the AMA is on the wrong side of history, the law, the guidelines, and reform.
This could lead to an even bigger issue that needs transparency and discussion—the medical bigotry of chirophobia that has led to back pain becoming the #1 disabling condition in the nation, the military, and in the world.
Shining the light on spine fusions and focus the lens of transparency to inform the public and payors of the lack of evidence supporting the hundreds of thousands of unnecessary spine surgeries done annually in the US would be invaluable.
This is a newsworthy story that every business owner and back pain patient needs to hear. This scam in spine care has been going on too long in American for-profit systems such as workers’ comp and private health insurances.
As editor Mark Schoene warns, “such an important area of medicine has fallen to this level of dysfunction should be a national scandal. In fact, this situation is bringing the United States disrespect internationally.”[vii]
This is a national scandal waiting to explode if the media made it an issue. Think of the millions of patients suffering from failed back surgery who finally learn of this “informed consent” law that was ignored by the majority of MDs and surgeons who railroaded them into risky drugs and fusions.
Perhaps if the media had been vigilant in Dallas about the antics of Dr. Christopher Duntsch, his illegal behavior might have been exposed and people’s lives saved. Even notable medical reporters like Sanjay Gupta @ CNN who is a neurosurgeon has not devoted any air time to exposing this spine care crisis or the sordid tale of Dr. Duntsch, a situation undoubtedly he is keenly familiar.
This medical oversight of failure to inform patients about inefficient spine care will make the Bad Drugs commercials seem pale in comparison. Imagine if every failed back surgery victim understood that they might have been helped before surgery by a chiropractor. The outcry would be deafening!
[My next commentary in this series will focus on another tactic to take in the medical war against chiropractors.]
[i] National Medicare fraud takedown results in charges against 243 individuals for approximately $712 million in false billing, HHS Press Office, June 18, 2015
[vi] Optum. Conservative Care: Ensuring the Right Provider for the Right Treatment, 2012.
[vii] U.S. Spine Care System in a State of Continuing Decline?, The BACKLetter, vol. 28, #10, 2012, pp.1