Expenditures associated with healthcare overuse account for between 10 and 30 percent of total healthcare spending, or at least 300 billion. According to a Health Affairs blog, a major player in that overuse is the poor treatment and management of low back pain which accounts for $86 billion in healthcare spending annually.
Overuse is defined in the post as "the provision of health care services for which potential harms outweigh potential benefits." It can come in various forms including unnecessary or risky diagnostic and screening tests, use of unnecessary or needlessly risky therapeutic procedures, and inappropriate use of medications.
Costly procedures for low back pain have been a driver in the rise of low back pain expenditures and have not yielded much improvement in outcomes. This overuse contradicts longstanding guidelines that promote aggressive exercise-based regiments during the "acute phase" of the pain as being more effective treatment. Still, the blog cited data showing that between 1999 and 2010, narcotics use spiked 50.8 percent, use of advanced imaging rose 56.9 percent, referrals to other physicians, some presumably for surgery, went up 106 percent, Health Affairs said.
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Diagnostic imaging also drives back-pain related costs because it often leads to more tests, referrals and surgeries. Recently, the use of newer narcotics despite their potential side-effects and controversy surrounding their use for chronic pain.
Health Affairs also said physician reimbursement methods and member insurance benefits can also enable overuse. Retrospective payment for services may encourage the provision of unnecessary tests and procedures, as well as upcoding for the maximum expected return per-patient visit, instead of following evidence-based practices. In terms of physical therapy, treatments and procedures that are poorly supported or not at all supported by clinical literature tend to have had higher reimbursement rates than those that have proven beneficial, Health Affairs said.
To illustrate the "less is more" theory as it pertains to treating low back pain, the blog spotlighted the experiences of pro golfer Tiger Woods and Golden State Warriors coach Steve Kerr. Woods has had four back surgeries and is still struggling and Kerr missed the majority of last season and this year's playoffs battling recurrent headaches and pain following back surgery.
The blog quoted Kerr from an April press conference where he said "I can tell you if you're listening out there, if you have a back problem, stay away from surgery. I can say that from the bottom of my heart. Rehab, rehab, rehab. Don't let anybody get in there."
They cited media reports that said Tiger Woods is still dealing with debilitating back pain and "additional consequences" related to side effects associated with opiate pain relievers, Health Affairs said.
"Sometimes, an influential story can be more impactful in changing public opinion than a mound of evidence. We should take this opportunity to discuss these important lessons about the risks of surgery, the downside of too much care, and the fact that spending more on health care does not necessarily deliver the best outcomes."