NCQA's New Spine Care Recognition Program to Identify Doctors Who Deliver Patient-Centered, Evidence-Based Care; 31 Million Suffer from Low Back Pain; Program Promotes Patient Education, Deliberative Approach to Care; Public Comment Through June 2.

WASHINGTON -- The National Committee for Quality Assurance (NCQA) today unveiled proposed measures for its new Spine Care Recognition Program. The program promotes excellence in treating back pain by recognizing physicians and chiropractors who deliver high-quality, evidence-based care and provide patients with a clear understanding of appropriate treatment options. The measures will be available for public comment through June 2.

Back pain is the most common and the most costly cause of work-related disability in America. It affects more than one of every 10 Americans each year, and treatment costs are estimated to be between $50 billion and $100 billion annually, making spine care a topic of major interest to patients, employers and other health care purchasers.

Patients with back pain often undergo tests such as x-rays and MRIs, and surgical procedures such as spinal fusion, that offer little or no demonstrable medical value and pose considerable risk. During the 'acute phase,' or first six weeks, of an episode of back pain, there is ample evidence that in nearly all cases physicians should advise patients to resume normal activity within a few days. Medical evidence also indicates that extended bed rest is not beneficial and may be harmful to patients living with back pain and that, except under specific circumstances, they do not need imaging or surgery.

"For patients living with lower back pain, less can really be more," said NCQA President Margaret E. O'Kane. "This program puts the principles of a deliberative approach to care into practice--noninvasive treatment alternatives should be explored before a patient receives an MRI or undergoes surgery. Patients of the physicians and chiropractors who earn Recognition will notice and appreciate the difference it will make in their care."

The program's measures assess whether physicians and chiropractors:

--Thoroughly review their patients' history of back pain symptoms, and their response to therapy;

--Advise their patients to resume normal daily activities within three to four days;

--Recommend exercise after the first six weeks of an episode;

--Review the risks and benefits of treatment options with their patients;

--Avoid costly interventions that, in the absence of certain defined conditions, have not been shown to improve patient outcomes, such as MRIs or surgery, during the first six weeks of an episode;

--Attempt a course of non-invasive treatment before recommending surgery, except under certain circumstances where surgery is indicated; and

--Avoid repeat imaging.

Purchasers, noting that the cost of spine care averages an estimated $8,000 per case, lauded the program's focus on evidence-based treatment. "Lower back pain is one of the most common causes of disability among our employees," said Pamela Hymel, M.D., Medical Director, Integrated Health, Cisco Systems, Inc. "And it's a condition for which a simple, low-risk approach has been shown to often be the most effective. We're committed to programs that result in the best care and best health outcomes for everyone in the Cisco family. That's why we support this program."

Physicians noted that NCQA's new measures credit a patient-centered approach to care. "Sharing information and involving patients in the decision-making process makes a real difference, especially when that person is in pain and may not understand that sometimes the best care is allowing the body to heal itself," said Richard A. Deyo, M.D., Professor, University of Washington School of Medicine. "NCQA's new program recognizes those doctors who, among other things, help their patients understand that needless procedures aren't helpful and can be counterproductive."

The Spine Care Recognition Program is NCQA's fourth Physician Recognition Program. The first three--the Diabetes Physician Recognition Program, developed in conjunction with the American Diabetes Association, the Heart/Stroke Recognition Program, developed in conjunction with the American Heart Association/American Stroke Association, and Physician Practice Connections--have collectively recognized nearly 4,000 physicians to date and serve as the basis of a number of major pay-for-performance initiatives.

Draft measures are available at NCQA's Web site, www.ncqa.org. Interested parties are invited to comment on the measures through June 2. Final measures and scoring for the program will be released after completion of the public comment period and pilot testing.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations, recognizes physicians and physician groups in key clinical areas and manages the evolution of HEDIS(R), 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.

HEDIS(R) is a registered trademark of the National Committee for Quality Assurance. All rights reserved.