I lived with spondylolisthesis and spinal stenosis for more than 10 years. Walking even 100 yards became nearly impossible because both of my legs would go completely numb. The active lifestyle I loved had gradually slipped away.
When I met with my surgeon, I learned about an FDA-approved alternative to spinal fusion that stabilizes the spine while preserving its natural motion. Instead of permanently fusing part of my spine, I had the opportunity to choose a treatment designed to relieve my symptoms while maintaining mobility.
The evening after surgery, I was already walking through the hospital without pain. Within six weeks, I was back on the pickleball court. Today, I play pickleball three or four days a week without back pain. I'm back on the golf course, too, with no restrictions on my swing.
The TOPS procedure as the procedure is called relieved my symptoms and gave me back the active lifestyle I thought I had lost.
That's why I'm concerned that future Medicare patients might no longer have the same opportunity I did because of a reimbursement issue.
When TOPS was first approved, Medicare created a temporary supplemental payment while enough real-world cost data were collected to establish a permanent hospital reimbursement. That temporary payment expires at the end of September. By then, Medicare would normally have updated its payment system to reflect the actual costs hospitals incur when providing the procedure. But that hasn't happened.
Despite receiving several years of hospital data demonstrating what it actually costs to provide this procedure, Medicare has not updated its payment classification. As a result, hospitals could soon receive substantially less than the cost of performing the surgery.
If that happens, many hospitals might have no choice but to stop offering TOPS to Medicare beneficiaries. Hospitals cannot continue providing procedures that are significantly underfunded.
The next Medicare patient suffering from the same condition I had may never be offered this option. Instead of learning about a motion-preserving alternative, they might be told that spinal fusion is the only procedure available.
I'm not an expert in Medicare payment policy. But I do know what this procedure means to me. It allowed me to avoid spinal fusion, return to the sports I love, and reclaim the active life I had been missing for more than a decade.
I hope Medicare will ensure that future patients have the same opportunity by extending the temporary payment while updating hospital reimbursement to reflect the cost of providing this innovative treatment.
Patients deserve access to the treatment that's right for them. I was fortunate to have that choice. I hope others won't lose it.
Tony Agnesi is a Medicare beneficiary from Wadsworth, Ohio.
