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Tens of Thousands of Back Pain Patients Overtreated in Six Health Plans, According to HealthCore Study
Date:3/16/2009

INDIANAPOLIS, March 16 /PRNewswire/ -- More than 35,000 people had unnecessary imaging tests and almost 1,000 underwent inappropriate back surgery less than six weeks after diagnosis, according to a study of six WellPoint-affiliated plans over a 12-month period, conducted by HealthCore, WellPoint's outcomes research subsidiary.

Many people with back pain -- a condition experienced by 9 out of 10 Americans at some point in their lives -- undergo imaging tests and surgeries much earlier than recommended by national guidelines on back pain.

"As Americans, we spend roughly as much on back problems as we do for cancer or diabetes with very little change in overall result," said Dr. Sam Nussbaum, WellPoint chief medical officer. "In some cases, invasive measures are necessary, but in most, they are not. Most people will get better without having the risk, pain and expense of surgery."

Most episodes of back pain resolve in six weeks, according to the National Committee on Quality Assurance 2007 Back Recognition Program. Yet, HealthCore's study showed that $23.6 million was spent on back surgery and diagnostic imaging during the first six weeks after members reported an episode of back pain.

"It's been well documented that 30 percent of health care spending goes toward redundant or inappropriate care(1)," said Dr. Joseph Singer, vice president of medical affairs for HealthCore. "Our health care system should use evidence-based decision-making processes, such as the NCQA guidelines, to deliver clinical services that improve the quality of life and productivity of Americans."

Lumbar injuries result in approximately $149 million in lost work days per year. The annual productivity losses resulting from lost work days are estimated to be $28 billion.(2) Back pain is estimated to make up one-third to one-fourth total workers' compensation costs.(2)

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SOURCE WellPoint, Inc.
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