Rolling Out the New Administration - What's Coming (and Going) for Back Pain Sufferers?

Photo: (c) Mark Wilson Getty Images

Past vice president Dick Cheney pulled a back muscle while moving out of Washington and into a new home in Virginia. He was ushered out of office in a wheelchair - doctor's orders. With the Bush/Cheney team gone, what do the rest of American back pain sufferers need from their leaders?

For myself, I must say I am glad that Barack Obama takes a more self-empowered view of health. In general, back troubles are the type of health concerns that greatly improve when the person takes a pro-active approach, as opposed to relying on the health care system for support. Admittedly there are exceptions to this, but 80% of back pain is thought to be muscle or posture related.

But back to my question. According to Cathy Ellis, Director of Physical Rehabilitation and the Spinal Cord Program at National Rehabilitation Hospital in Washington DC, peer programs for people with spinal cord injury are the most effective way to successfully deliver services to this patient population. The NRH is a national leader in research and advocacy for people with SCI. One of their missions is to break down the communication and understanding barriers between clinician and patient. They do this by recruiting research staff from their patient base, and employing people with spinal cord injury as “navigators” for those newly diagnosed with the condition. The Bush administration has provided funding for the NRH’s groundbreaking research, but the hospital is looking to the Obama administration for more.

Ellis also notes that in some states and in DC Medicaid will not pay for preventative measures such as home based physical therapy for patients with spinal cord injury. The glaring discrepancy in this policy is that Medicaid will pay for outpatient physical therapy and transportation to get to it, but not for home care PT necessary for those patients for whom walking and self-care is impossible. This means that home bound patients unable to safely get to their physical therapy appointments are prohibited from obtaining needed therapy, and often resort to nursing home placement instead. Nursing home care is far more expensive for the Medicaid/Medicare system than outpatient therapy and transportation.

Another concern for persons with spinal cord injury are pressure sores (also called pressure ulcers). Pressure sores occur when the body must stay in one position for long periods of times, as is often the case with persons living with a spinal cord injury. Pressure sores are preventable, but to a large extent, this medical fact seems to have escaped the attention of health care policy makers and claims managers. Many insurance companies will cover an inpatient hospital stay for surgery for the pressure sores, but will not pay for the much less expensive cushions, wheelchairs and transportation that can help avoid the need for surgery in the first place.

I am looking forward to the implementation of health care policies that emphasize prevention and put the patient in charge of her well-being. Nearly all of us could benefit from being more pro-active about our back and neck health. And I hope that Medicare and Medicaid will soon begin to address the needs of the patient as a first priority, rather than automatically limiting coverage to only the most expensive items on their menus.