Due to the COVID-19 emergency, HealthPartners is temporarily suspending the medical spine specialist evaluation requirement prior to seeing a spine surgeon until further notice. For more information, please review the May 2020 edition of the Fast Facts newsletter.
HealthPartners uses a comprehensive integrated approach to low back pain management that optimizes multiple care delivery components.
Aligned with ICSI's Low Back Pain guideline, we have identified an approach to networks and resources to support clinicians' efforts in caring for patients with acute and chronic low back pain.
Designated Medical Spine Centers:
are selected through a formal process and demonstrated expertise in spine care management that supports both primary and surgical clinicians that see patients that are potential surgical candidates.
Spine Surgery Resources:
provides helpful information on medical policy and administrative procedures for spine surgery office consult visits and procedures.
STEP 1: Primary Clinician
Recommends and coordinates a medical spine center visit.
STEP 2: Medical Spine Specialist
Completes comprehensive evaluation and recommends a treatment plan. A copy of this treatment plan will be sent to the primary clinician.
STEP 3: Spine Surgeon
If the patient continues on to see a Spine Surgeon for their lumbar back pain, the first office visit will require prior notification.
Learn more about Back Pain
For general questions, please contact your contract manager or service specialist.
- For questions regarding Medical policy call 952-883-5724
Considering sending your lumbar back pain patient to an orthopedic or neurosurgeon?
Follow these simple steps:
- Schedule a medical spine specialist evaluation, except in emergent conditions.
- You can recommend an MSC from the listing under Practitioner Resources.
- An MSC Patient Handout describing what to expect is under Handouts. Or
- Direct your patient to call HPI member services number on the back of their card.
- After the medical spine visit, a copy of the evaluation will be sent to you. Your patient may decide whether to schedule the first spine surgery office visit. This decision is made by the patient and/or you regardless of the recommendation of the Medical Spine Center (MSC) specialist.
Practitioner Resources
For specific MSC geographic area:
Patient Education and Handouts
Improving Non-malignant Pain care: Opportunity & Resources
The Opportunity
- Underutilization of clinical alternatives to prescription opioids have contributed to our national opioid epidemic.
- Recent guidelines recommend physical therapy, weight loss, and cognitive behavioral therapy as safe alternatives to treat chronic pain.
- Early physical therapy following a new primary care consultation for low back pain was associated with reduced risk of subsequent health care compared to delayed physical therapy.(Fritz, 2012)
- Patient's receiving "early and adherent" physical therapy had 60% lower total low back pain related costs over 2-yrs.(Childs, 2015)
- Twenty six states including Minnesota and Wisconsin have passed rules that allow patients to see a physical therapist on their own without having a referral from a physician.
https://www.cdc.gov/opioids/
Reversing the Opioid Epidemic
Best Practice Prescribing & Provider Resource Toolkit
Early Access to Pain Management Alternatives
- Consider a "First-line" physical therapy triage protocol for patients seeking initial care of pain.
- #ChoosePT(The American Physical Therapy Association)
Designated Medical Spine Center Network Providers
Medical Spine Centers are clinics with medical spine specialists certified in Physical Medicine and Rehabilitation, Occupational Medicine, Sports Medicine or Clinicians with advanced extensive training in spine care.
The Centers are committed to:
- A biopsychosocial active reconditioning model
- Evidence based practices as demonstrated by use of ICSI guidelines and written, evidence-driven protocols
- Support primary care and surgical practices seeing low back pain patients that are potential surgical candidates
- Support patients in choices for their treatment using a formal shared decision making process
- Access standards
- Multi-disciplinary care treatment method
Designated Medical Spine Centers
Practitioner Resources
For a Quick Overview on the Approach:
Toolkit
Patient Education and Handouts
For specific MSC geographic area:
Practitioner Resources
The Spine Surgical Practice Low Back Pain Office visit policy requirements have been revised.
- Low back pain patients with Medicare Advantage benefit coverage will be exempt from having to see a medical spine specialist prior to an initial surgical office visit.
- The Prior Authorization (PA) requirement has been changed to a Prior Notification (PN) requirement.
- Spine Surgical practices must submit a completed PN form prior to seeing the patient for the initial office visit for low back pain
- Office visits claims without prior notification by the surgical practice will be denied to provider liability
Spine Surgical Practice Office Visits - Medical Policy
Spine Surgery Visits - Administrative Policy
Spine Surgery Procedures - Medical Policy
