August 4, 2005

NCQA to Develop Program That Will Help Improve
Care for 31 Million Individuals With Chronic Back Pain

NCQA begins development of new Spine Care Recognition Program;
 Spine Care Advisory Committee holds first meeting

WASHINGTON— The National Committee for Quality Assurance (NCQA) announced today that it has begun development of a new program to identify physicians who provide high quality, patient-centered care for chronic back pain.  Back pain is the nation’s leading cause of disability for people under the age of 45 and affects 31 million people annually at a cost of $50 billion to $100 billion annually in direct medical and indirect costs. Nevertheless, diagnosis and treatment of back pain remain uneven in the U.S.; unnecessary diagnostic imaging and surgery are common, yet at the same time many patients never receive recommended care. 

To help guide the development of the program, NCQA convened a 15-member Spine Care Advisory Committee (see attached list) on July 29.   NCQA expects to launch its new Spine Care Recognition Program in late 2006.

“In many cases, back pain is treated with unnecessary surgery that still leaves the patient in pain,” said NCQA President Margaret E. O’Kane. “This program will steer people to doctors who not only know how to diagnose back problems, but who also explain the pros and cons of treatment options, help them manage their condition and get well again.”  

Using Medicare data, researchers from Dartmouth showed that the treatment of back pain varied greatly from one part of the country to another; spinal fusion surgery, for example, shows the greatest variation from place to place of any surgery in the country.  Such variations are an indication that an inappropriate regional bias plays a role in determining what care a patient receives. These variations also indicate that not all care being delivered is consistent with “best practices” that define optimal care. NCQA’s new program is designed to promote evidence-based medicine and involve patients in making decisions about what treatment is right for them.  

“Back pain is one of the most common and expensive causes of disability in the U.S.,” said Richard Deyo, M.D., Chairman of the Advisory Committee and Professor, School of Medicine, Departments of Medicine and Health Services, University of Washington. “Yet millions of Americans get substandard care for back pain; there’s tremendous potential for improving outcomes and controlling costs by helping doctors and patients make more informed choices in this area.” 

Back pain is of special concern to employers because of related costs. “Spine care is one of the most important concerns of employers, as it accounts for 25 percent of all lost work days,” said Helen Darling, President of the National Business Group on Health. “Inconsistent and poor quality lower back pain treatment in the U.S. translates into billions of dollars wasted on unnecessary tests and procedures, and a lower quality of life for those patients who undergo a surgery they don’t need. The development and use of evidence-based guidelines for treatment of spinal injuries is welcome news.”              

The Spine Care Advisory Panel brings together diverse stakeholders, including leading clinical researchers from different specialties, employers, health plans and disability insurers. Incorporating a variety of perspectives, including those of successful spine care programs, will help facilitate NCQA’s understanding of expectations for the industry during development of the program. The Spine Care Advisory Committee will:  

Provide input on all aspects of the new recognition program  
Provide advice on appropriate, evidence-based performance measures 
Serve as a forum for promoting and building consensus for the new program.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS, the tool the nation’s health plans use to measure and report on their performance. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.

SPINE CARE ADVISORY COMMITTEE MEMBERS    

Richard Deyo, M.D. (chair)
University of Washington, Department of Medicine   

Gunnar Andersson, M.D., Ph.D.
Rush University Medical Center 

Douglas Dammrose, M.D.
BlueCross of Idaho Health Service, Inc  
 
David Deitz, M.D., Ph.D
Liberty Mutual Insurance   

Peter Gerszten, M.D., MPH
University of Pittsburgh, Department of Neurological Surgery  
 
Jordan Ginsburg, M.D.
UnitedHealthcare
  
Linda Golodner
National Consumers League   

Ken Grossman, M.D.
General Electric   

Pamela Hymel, M.D.
CISCO Systems   

Jeffrey Katz, M.D.
Brigham and Women’s Hospital Division of Rheumatology and Immunology 
 
Tom Marr, M.D.
HealthPartners 
 
John J. Triano, D.C., Ph.D.
Texas Back Center  

Jan Vest
Signature Health Services, Inc.   

William Charles Watters, III, M.D.
Baylor College of Medicine
Representative of the American Association of Orthopaedic Surgeons  
 
James Weinstein, D.O., M.S.
Dartmouth-Hitchcock Medical Center, Department of Orthopaedic Surgery