STJ Arthroereisis: Implanting Some Thoughts On The Prevailing Lack Of Insurance Coverage

Allen Jacobs DPM FACFAS

If you were to take the time to do so, you would find that many insurance carrier policies exclude coverage for subtalar joint (STJ) arthroeresis, characterizing it as investigational or even experimental.

Anthem Blue Cross and Blue Shield, for example, refers to the American Academy of Orthopaedic Surgeons (AAOS) for acceptable means of treating flatfoot deformity. Since the AAOS does not recognize the procedure as proven, the procedure is not covered. Most insurance carrier policies that I reviewed acknowledge the numerous publications in existence regarding the use of STJ arthroereisis yet continue to deny payment for this procedure.

Any podiatric surgeon performing this procedure knows that subtalar joint arthroereisis is both safe and effective in properly selected patients.

In some states, the use of great toe implants for the treatment of advanced osteoarthritis continues to undergo challenges by some insurance carriers, who call this experimental or investigational. At the same time, the same carriers will pay for ankle joint implants, some of which have less patient experience than either subtalar joint arthroereisis or great toe implant surgery.

Why? Although I have my own thoughts on this, I will allow you to draw your own conclusions.

I would suggest that some problems may exist on our side of the equation. When I read about certain individuals who have performed 300, 400, 500 or more of these arthroereisis procedures, I admit some concern over the procedure indications, which have brought the practitioner to those numbers.

One online advertisement for an arthroereisis device claims success in treating back pain, shoulder pain and even temporomandibular joint (TMJ). The manufacturer of the device grants a “master surgeon's certificate” to those who attend the “course” of an individual who lectures for this company. The individual lecturer has also reportedly suggested that a subtalar joint arthroereisis, by virtue of improving foot function and thereby increasing the ability to stand or walk, will reduce the incidence of diabetes and obesity in the future.

At a recent educational meeting, another lecturer suggested the use of a great toe implant that he had used only one time with little clinical follow-up.

We all attend meetings in which companies attempt to have us utilize newly fashioned orthopedic devices that have little or no clinical experience behind them. One prominent podiatric “institute” received an FDA fine of several hundred thousand dollars and got banned for at least two years for the falsification of information submitted to the FDA for device approval.

How can an arthroereisis manufacturer state that a device is accepted by “most insurances” when most do not cover the device? How can insurance carriers call a great toe implant “investigational?” Why would an alleged educational institute allow someone to endorse an implant used only once at the time of endorsement with little clinical follow-up?

I believe the average podiatrist had better wake up and smell the roses … er, the money. While you may use new devices and techniques in a good faith effort to help someone, if there is not adequate evidence to support these modalities, you are at risk for poor or disappointing patient outcomes, income loss and potential litigation.

The implant and technique developers, the lecturers and the people consulting with the involved corporations will continue to get checks every month. Do yourselves and your patients a big favor. Do not blindly accept the recommendations of thought leaders without asking who is paying whom.

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