Diagnosis and treatment of back-pain–related conditions make up a large component of many orthopaedic practices. As shown in the accompanying “Facts about back pain,” the economic impact of low back pain is extremely high and represents a significant component of rapidly rising healthcare costs.

Although a strong clinical evidence base for treating both acute and chronic back pain exists, substantial quality gaps remain. Standards of care for back pain vary widely from one region of the country to another, and considerable controversy exists within the orthopaedic community on the “best” treatment. (See March/April AAOS Now, “No easy answers on disk herniation surgery,” at www.aaos.org/now)

Accordingly, both public and private healthcare payors are looking for opportunities to address these quality gaps, reduce unnecessary overuse of medical care, and lower costs.

The NCQA Back Care Recognition Program
In response to this growing cost-of-care crisis, the National Committee for Quality Assurance (NCQA), a Washington, D.C.-based nonprofit organization that accredits managed healthcare plans, recently announced the launch of a new Back Care Recognition Program (BCRP).

The BCRP provides an opportunity for healthcare professionals—including primary care physicians, orthopaedists, osteopaths, and chiropractors, among other specialties—to participate in a structured national program to collect and measure data relating to the quality of their care decisions in treating acute, subacute, and chronic back pain, as measured against evidence-based statistical benchmarks. The program includes a data collection tool, a set of standardized quality measures, and the publication of a “recognition score” that rates the participating physician’s performance against established benchmarks.

Table 1 outlines the program’s point system and clinical measures/structural standards. Physicians who score 40 points or higher on the 100-point scale qualify for recognition under the program. Every two years, the physician must resubmit recent performance data to maintain recognition status.

The NCQA developed the BCRP in cooperation with a panel of physicians representing multiple specialties; chiropractors, public health experts, health plans, and employers also provided input. William C. Watters III, MD; Gunnar B.J. Andersson, MD, PhD; and James Weinstein, DO, MS, were among the AAOS fellows who sat on this panel and directly contributed to BCRP’s final format. Associate member Jeffrey N. Katz, MD, also participated, representing rheumatology.

What does recognition entail?
Physicians who qualify for recognition will have their names and practice locations published on the NCQA’s Web site. Their names will also be “widely distributed,” according to NCQA. As with the organization’s other recognition programs (diabetes, heart/stroke, and physician practices), the NCQA predicts that “many health plans and employers will offer rewards to BPRP-recognized physicians.” For example, the Bridges to Excellence program has already announced that it is establishing a Spine Care Link that will provide bonuses and other financial incentives to BPRP-recognized physicians. The NCQA also notes that where applicable, physicians can use recognition to help establish eligibility for pay-for-performance bonuses or differential reimbursement from payors and health plans.

NCQA is now accepting applications from physicians interested in participating in the BCRP. Further information and an application form are available on the NCQA Web site, www.ncqa.org

Jill Elaine Hughes is AAOS Clinical Quality Improvement Coordinator. She can be reached at hughes@aaos.org.

Facts about back pain

• Back pain is the most widespread orthopaedic condition in the United States; each year, 1 in 9 Americans, or 11 percent of the U.S. population, experience an episode of back pain severe enough to impair their usual daily activities.¹
• Back pain is second only to the common cold as the principal cause for physician visits in the United States.
• Treating back pain accounts for approximately $91 billion a year in healthcare costs.
• Back pain is also the most frequent cause of workers compensation claims in the United States, accounting for one fourth of all such claims and resulting in huge social and economic costs for workers, employers, and society at large.²
• Although only 1 in 20 (5 percent) of all patients with back pain become temporarily or permanently disabled, these patients can account for up to 75 percent of the total cost-of-care burden for the entire patient group.³

1. Carey TS, Evans AT, Hadler NM, et al: Acute severe low back pain: A population-based study of prevalence and care-seeking. Spine 1996;21:339-344.
2. Klein BP, Jensen RC, Sanderson LM: Assessment of workers’ compensation claims on back strains/sprains. J Occup Med 1984:26:443-448.
3. American Academy of Orthopaedic Surgeons and North American Spine Society: Clinical Guideline on Low Back Pain—Phase I. 1996.