Becker's Spine Review

14 SPINE SURGEONS Dr. Paul Matz breaks down NASS' clinical guidelines for treatment of low back pain By Alan Condon T he North American Spine Society published guidelines Jan. 29 for the diagnosis and treatment of low back pain in adult patients. e publication, "Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis and Treatment of Low Back Pain," focuses on 82 clinical questions and is the larg- est clinical guidelines that NASS has produced. Paul Matz, MD, a neurosurgeon with Casper- based Wyoming Neurosurgery and Spine and the NASS evidence-based guideline develop- ment committee co-chair, spoke to Becker's Spine Review about the motivation behind the guidelines and what he hopes it will achieve. Question: What was the motivation and the end-goal behind the NASS clinical guidelines? Dr. Paul Matz: Prior guidelines had focused on a specific disease entity and NASS wanted to tackle one on a very broad entity, simply because low back pain is so common and af- fects so many people, and because there really hasn't been a comprehensive review of it. As NASS is a multidisciplinary organization fo- cusing on spine, the consensus was that other guidelines that looked at low back pain had really been from the perspective of the type of group that did the examination and there hadn't been a multidisciplinary group that looked at such a broad question. So that's why NASS chose to undertake it, knowing the trepidation that it was such a broad subject. Q: What was the biggest point of contention in the guidelines? PM: Well, it started with the definition. Be- cause when you say, 'low back pain,' are you simply saying isolated low back pain or are you saying low back pain with radiculopathy? So, a lot of the time was spent on trying to define isolated low back pain. What we settled on was low back pain that didn't radiate below the knee, with the idea that some radiation in the thigh can be produced by low back pain. e important thing was we settled on non-radicular low back pain. But the issue with that was that there are a lot of clinical studies when we ask questions that included radicular pain, and if they didn't isolate the subgroups — meaning the patients with low back pain without radicular pain and those with it — we had to exclude that study. Your guideline conclusions are only as good as the studies you include, so that in some ways probably affected the conclusions that we had relative to the guidelines, compared to some other ones that may have included radicular pain. I think that was probably the biggest point of contention. Q: Do payers look at these guide- lines? If so, how do you think they will interpret them? PM: I suspect that yes, they will look at them. But there is always that concern: Will the guidelines affect my patient's coverage for cer- tain treatments? NASS' clinical guidelines are intended as educational documents and we include a statement that they're not standards of care, nor should they be used as the sole reason for denial of treatment and services. In a very broad subject, if you look at where we are now and where we can move to, you need a review, and that's what the guidelines offer. ere's always the concern that it could affect coverage, but that's not the intent. e intent is, if a payer looks at it, to use it as an educational device and use it as a way to move forward, as opposed to using it as a sole reason. n Colorado neurosurgeon, spine implant companies to pay $2.35M in anti-kickback settlement: 5 details By Laura Dyrda A Colorado neurosurgeon and multiple distributor- ships paid millions to resolve anti-kickback and False Claims Act violation allegations, according to a release from the U.S. Attorney's Office District of Colorado. Five details: 1. William Choi, MD, allegedly created two spine implant distributorships, Nexus Spine in 2011 and 4D Spine in 2015, that produced spinal implants and devices that he used during surgical procedures. When he registered the companies, he listed third parties as owners but secretly had control of both distributorships. 2. Dr. Choi financially benefitted from both companies, allegedly receiving improper payments and benefits due to his ownership. Federal programs, including Medicare and Tricare, paid for spine procedures Dr. Choi performed under this unlawful arrangement from November 2012 through June 2017. 3. Mark Rahe, who worked at Dr. Choi's practice and 4D Spine, filed the lawsuit against Dr. Choi claiming knowl- edge of the illegal arrangement. 4. Dr. Choi and three companies he owned, including Nex- us Spine and 4D Spine, agreed to pay $2.35 million to re- solve the allegations. As the individual who first brought the lawsuit against Dr. Choi, Mr. Rahe will receive a portion of the settlement. 5. The settlement resolved civil allegations against Dr. Choi, and he did not admit liability. n

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