NASS Takes a Proactive Approach to Evidence-Based Coverage Decisions

Dr. William Watters

In an effort to improve patient access to appropriate, evidence-based care, the North American Spine Society (NASS) recently released detailed policy recommendations for coverage of 13 common spine care treatments, procedures and diagnostics.The first-of-their-kind reference documents outline when it is … and when it is not … appropriate to utilize each of the options based on an extensive review of current literature by a multidisciplinary team of experts.

William Watters, MD, president of NASS, said, “Maintaining patient access to high-quality, evidence-based and ethical spine care is the single most important part of NASS’ mission. It is our hope that payers, spine specialists and their patients will use these evidence-based coverage recommendations as a reference to advocate for appropriate care for patients.”

Watters added the society was uniquely positioned to take the lead on such an extensive project because of the multispecialty nature of the organization, which includes the expertise of surgeons and allied health professionals. “We cover the full spectrum of spine care,” he noted.

Watters, who is a board certified orthopaedic surgeon in private practice at the Bone & Joint Clinic of Houston and a clinical associate professor at both the University of Texas Medical Branch in Galveston and Baylor College of Medicine, said the society already had experience weighing the evidence at the request of physicians, patients and payers. “NASS began a number of years ago becoming involved in third party payer coverage decisions,” he noted. However, he continued, the turnaround time was often tight and the number of studies to consider extensive.

“We decided to proactively create our own coverage decisions based on the best evidence available … and where evidence was lacking, based on the expertise in this group,” he explained. “We came up with what we feel is the most sound group of recommendations based on the best evidence available at this point and time.”

Watters continued, “One of the hopes that we have is that we bring a bit of uniformity to the whole process of spinal care.”

Christopher Kauffman, MD, health policy council director for NASS, concurred. He said allowed treatments and diagnostics vary by state and by payer. These recommendations outline the scope and clinical indications for a therapeutic measure when a patient meets appropriate inclusion criteria. They also clearly state scenarios in which employing the measure is not indicated.