Josiah Morse, MPH
Program Director
Washington State Healthcare Authority
Health Technology Assessment Program
P.O. Box 42712
Olympia, WA 98504-2712
SUBJECT: Non-coverage Decision for Washington State HTA Re-review of Lumbar
Spinal Fusion for Degenerative Disc Disease: 20151120A
Dear Mr. Morse:
On behalf of the American Association of Neurological Surgeons (AANS), the Congress of
Neurological Surgeons (CNS), the AANS/CNS Joint Section on Disorders of the Spine and Peripheral
Nerves and the Washington State Association of Neurological Surgeons (WSANS), we would like to
express our disappointment with the decision of the Washington State Healthcare Authority (HCA)
Health Technology Assessment (HTA) program Health Technology Clinical Committee (HTCC) not to
cover lumbar spinal fusion for degenerative disc disease (DDD).
We strongly disagree with the process, as well as the content of the draft findings and decision
rendered by the HTCC on Nov. 20, 2015. Our professional societies are seriously concerned that
patients experiencing certain forms of severe life-altering low back pain, which has been shown to be
refractory to all appropriate forms of nonoperative care, will be denied access to effective surgical
treatment. To be clear, we support the 2007 Lumbar Fusion for DDD decision, which permitted
coverage under certain conditions following a period of nonoperative care. However, the recent
decision is not compatible with the latest scientific evidence, nor does it reflect our professional
experience of caring for our patients.
We believe the findings posted, as well as the process leading up to this decision, ignore fundamental
scientific principles. The selected key questions were biased, the clinical research organization
(CRO) utilized was conflicted, and the HTCC continued to disregard constructively rendered public
comments voiced by true experts in the field at all stages of the narrowly permitted public comment
periods. By assigning the power of law to all affected state agencies (RCW 70.14.080-14), the HTCC
and the HCA assume absolute medical decision-making powers over many Washington state citizens
— without affording a mechanism for appeal. We believe that this inappropriately interferes with the
doctor-patient relationship and will lead to undue hardship, despair, and unintended negative
consequences for those individuals who have failed all appropriate nonoperative care.
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Read full letter here
