A Pain in the Wallet

Planning to get spinal fusion surgery? It might be cheaper to buy a first-class ticket to Cleveland, Ohio, or St. Louis, Mo., than get the procedure done closer to home.

A new study published in the medical journal Spine shows how much surgical costs vary from region to region.

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Spinal surgery is cheapest in the Midwest and costliest in the Northeast.

“Analysis of geographic trends showed statistically significant differences in costs,” said orthopedic surgeon Dr. William Ryan Spiker and his co-authors, who are researchers at the University of Utah at Salt Lake City.

To find these regional differences, Spiker and his team analyzed 2012 Medicare data for the costs associated with two of the most common spinal fusion procedures — anterior cervical discectomy and fusion, or ACDF, and posterolateral fusion, or PLF. They also examined Medicare data for total knee replacement surgery to see whether the geographic price differences were unique to spinal procedures or part of a larger trend.

Related: Get Off the Pain Train

As in the case of spinal surgeries, knee surgery costs also varied significantly by geography and even followed the same pattern — the Midwest was cheapest, the Northeast the costliest. The authors postulate that other common surgeries likely follow this pattern as well.

Why is this important? Spinal surgeries are becoming increasingly popular. An estimated 3.6 million spinal fusion surgeries were performed in the United States between 2001 and 2010. They were associated with more than $287 billion in total charges.

An estimated 3.6 million spinal fusion surgeries were performed in the United States between 2001 and 2010, and were associated with more than $287 billion in total charges.

The number of spinal procedures performed annually nearly doubled between 2001 and 2011, according to the Agency for Healthcare Research and Quality. And experts predict that number will continue to grow as baby boomers age but remain active. The surgery also will become less invasive as more effective surgical procedures are developed. Medicare will pick up much of this tab.

Many private health insurers have begun implementing regulations — requiring a minimum number of months of physical therapy — before approving surgery as a last resort.

“The high prevalence of spine disease in the United States, and the prevalence of spinal fusion surgery, increase the importance of optimizing value in this group of procedures,” the study states.

Variations in cost are a natural part of free market medicine, and any government micromanagement of medical decision-making will only hurt patients, doctors, and the practice of medicine.

But it’s unlikely that most people who need spinal surgery will travel long distances to get the procedure done.

“When you’re in extreme pain, traveling may not even be an option for you,” said Tessa Lou Fix, who suffers from spinal damage and chronic pain, the results of four major car accidents.

At age 37, Fix is now considering spinal surgery to help alleviate her chronic pain. But as a single mother and small business owner living in New York City, the cost is a huge issue.

“In New York City, everything costs more. The cost of life is more, but you earn more here. It’s all relative,” she said.

New York ranked among the states with the highest costs for these procedures. The study found a “strong correlation” between a state’s cost of living and the cost of the procedures. But cost of living alone didn’t explain the price differences. Other factors include the rate of referrals to specialists, how much care occurs in the hospital as opposed to an outpatient setting, and prescribing patterns, to name a few. Several studies have shown that physicians in different parts of the country practice medicine differently; that also affects cost.

Related: The Surgeon You Should Know

“These data shed light on the actual cost of common surgical procedures throughout the United States and will allow further progress toward the development of cost-effective, value-driven care,” the report states.

To many conservatives, that sounds a lot like “comparative effectiveness research,” a signature element of the Affordable Care Act. They argue that variations in cost are a natural part of free market medicine, and any government micromanagement of medical decision-making will only hurt patients, doctors, and the practice of medicine.

Fix said she understands the argument for more uniform care, because poor people may not be getting decent care. But she doesn’t want her doctor’s hands tied, she said.

“I find certain standards and bureaucratic involvement very frustrating, and they can really mess up a person’s health and life,” she said.

As someone with a complex diagnosis — one that varies depending on the doctor she’s seeing — bureaucratic involvement “sounds scary … because you then have less choice or opportunity for out-of-the-box thinking for how to care for certain health problems, especially those that don’t fit in a box.”