RICHLAND — A little-known state committee today will consider whether state health care programs should continue to pay for spinal injection treatments for back and neck pain.
But a Richland pain medicine specialist worries that patients will be driven either to narcotic pain medicines or expensive surgeries if the state stops paying for the injections.
He also worries the state will set a precedent that private insurance companies soon will follow.
"First, they will deny payment," said Dr. Bing Manawadu. "They won't fund it. Soon private payers will follow the government-mandated payment policies. It will deny access to the patients of Washington. Patients would have to pay cash or leave the state (for treatment)."
The treatment has been under review by the Health Technology Assessment Program since late 2009. The program identifies health care technologies to review for safety and effectiveness, essentially making sure the state and patients are getting the best bang for their buck.
Leah Hole-Curry, assessment program manager, said the program was created by the Legislature and is directed by statute to evaluate medical technologies for safety, efficacy and cost-effectiveness.
The program evaluates about a dozen technologies each year, which involves hiring an independent third-party research group to collect evidence about a given technology and then provide a report to the program.
The report includes information from medical literature as well as whatever public comments are submitted by doctors, patients or the general public, Hole-Curry said.
The researchers don't make any recommendations about whether the state should continue paying for a type of treatment. That decision is made by an 11-member committee made up of health care professionals, she said.
Also being considered by the committee today is the use of glucose testing in children.
The committee has made decisions on 21 technologies to date.
According to program records, a technology was deemed to have some benefit and coverage was supported in 11 cases. But in nine cases, the committee decided a technology did not provide a benefit and opted not to cover it.
Only one technology was shown to be unsafe or ineffective.
Some of the technologies or procedures the committee decided not to cover include bariatric surgery for minors, virtual colonoscopies and arthroscopic knee surgery.
The committee found some merit to technologies such as breast MRIs, cardiac stents, computer-navigated knee surgery and artificial disc replacements.
The report on spinal injections, prepared by a company called Spectrum Research, found from a review of medical literature that there was little or no benefit to patients from the use of spinal injections, such as epidurals, to manage back and neck pain.
But Manawadu said the report is flawed and that he's seen first-hand what the injections have done for hundreds of patients.
"They did not ask people like myself in the trenches taking care of these problems," he said. "They didn't want to listen."
Manawadu said the term "spinal injections" covers a number of procedures that involve injecting chemicals into the spine or nerve roots.
He said they are relatively noninvasive and allow a patient to go home the same day, compared to a back surgery that would have a patient in the hospital for days and take months of recovery time.
"(Injections) are effective in controlling pain and various conditions that affect the spine," he said.
The only alternatives are opiates -- which can have long-term health effects -- or surgery.
He said a spinal injection typically costs less than $1,000, but surgery costs tens of thousands, depending on the procedure.
"My bottom line on this is it will actually increase the cost," he said. "This is a short-sighted thing. It will save money in the short term, but in the long-term it will lead to increased costs and increased human suffering."
If the committee makes a decision today, a draft of the decision will become available for comment. A final decision would be made at the committee's next quarterly meeting.