In Health Affairs, Katharine Cooper Wulff, Franklin Miller, and Steven Pearson tell the fascinating story of coverage for percutaneous vertebroplasty, the treatment of vertebral fractures by injecting bone cement into the spine.
In August 2009, results from a pair of rigorous double-blind randomized controlled trials were published and reported that vertebroplasty provided no better pain relief than a sham procedure in which needles were introduced into the back without injecting cement. More than two years after publication of the two studies, insurers’ coverage of the procedure continues unchanged. […]
Some private payers thought that if Medicare moved first to use the new evidence as the basis for different coverage policies, then private payers could follow. But without action from Medicare, many private payers believed that they lacked the legitimacy to lead in adjusting coverage; “their hands were tied,” as one put it. […]
However, for several reasons Medicare did not decide to launch a national coverage determination process. That process ultimately could have led to a coverage determination that superseded the positive coverage decisions by the regional contractors. Why didn’t that happen?
This excerpt* does not do the paper justice; it’s far better. It’s also ungated.
* The paragraphs of this excerpt appear in a different order in the paper.