Issue Focus: Washington State Non-Coverage of SCS for work comp patients

For more than a decade, the Washington State Department of Labor and Industries (L&I) has had a standing non-coverage decision for spinal cord stimulation, despite its widespread coverage by private payers, Medicare, and the Veteran's Administration. As far as we can determine, Washington is the only state that denies SCS to workers' compensation patients.

This non-coverage policy does not distinguish between types of neuropathic pain (i.e., between pain caused by failed back surgery syndrome or chronic regional pain syndrome).

In 2004, in response to proposed legislation that would require coverage, members of the legislature instead directed L&I to commission a study to evaluate the impact of SCS on work comp patients. That study (conducted by researchers at the University of Washington) was recently completed and can be downloaded here: http://www.lni.wa.gov/ClaimsIns/Files/OMD/FinalReportSCS.pdf.

We disagree with elements of this study's design, and we do not believe that definitive conclusions and coverage decisions can or should be made on one study at this level—a study with conclusions that stand in stark contrast to the entire body of existing literature, including RCTs. Our actions include the following

NTAC Actions:

In May 2008, prior to publication of the UW study, NTAC representatives—along with Richard North, MD (Neuromodulation Foundation) and Joe Jasper, MD (WSIPP)—met with the director of L&I, Judy Schurke, to highlight the significant limitations in the study.

In November 2008, NTAC attended a meeting of the Industrial Insurance Medical Advisory Committee (IIMAC), during which one of the study authors (Professor Turner) presented on the results of the study and its conclusions.