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August 15, 2013

Orthopaedic Groups Urge Oregon HERC to Revise FAI Guidance

Washington, DC— In response to the proposed “no coverage” determination on hip surgery procedures for Femoroacetabular Impingement Syndrome (FAI) put forth by the Oregon Health Evidence Review Commission (HERC), physician groups, including the American Association of Orthopaedic Surgeons, the Arthroscopy Association of North America, and the American Orthopaedic Society for Sports Medicine, are urging HERC to revise its coverage recommendation.

Surgical correction of symptomatic FAI, a painful hip joint condition, is covered by all national U.S. commercial insurers as well as Medicare. Additionally, since 2008, six independent systematic reviews of FAI surgery have concluded that published evidence supports its safety and effectiveness. More than 40 peer-reviewed publications for symptomatic FAI using arthroscopic, open, or a combination of these surgical approaches also report that patients’ symptoms are relieved and they are able to return to their normal activity levels. However, the HERC has chosen to ignore these facts and recommend “no coverage” for FAI surgery.

The American Association of Orthopaedic Surgeons (AAOS), which represents 98% of the orthopaedic surgeons practicing in the United States and 368 surgeons practicing in Oregon, recently submitted a letter expressing its concern about the recommendation. “We oppose the proposed determination put forth by the HERC because we do not believe this decision is consistent with evidence showing that surgery is a cost-effective treatment for the management of FAI Syndrome,” stated AAOS President Joshua J. Jacobs, MD. “Surgical treatment of FAI for symptomatic patients with ongoing disability issues can provide long-lasting symptom relief and allows these patients to return to work or other desired activities, reducing FAI’s economic burden on society.”

The Arthroscopy Association of North America (AANA) joins AAOS in its concern. “The Oregon HERC’s effort to apply science to clinical health care is commendable, but their flawed methodology ignores the overwhelming scientific body of evidence supporting the role for surgical correction of femoroacetabular impingement (FAI) while no literature suggests that it is not effective,” stated J. W. Thomas Byrd, MD, President of AANA. “Most concerning, however, is that through the action of the Oregon HERC, a procedure recognized as being appropriate by virtually every authoritative organization in the world is being denied to a small subsection of the population that is least capable of mounting a voice on their own behalf.”

The American Orthopaedic Society for Sports Medicine (AOSSM) also expressed concern over Oregon's decision to not cover surgery for patients who suffer from FAI. “Surgical treatment of FAI is an important treatment option for patients who do not respond to conservative management of their condition,” stated AOSSM President Jo A. Hannafin, MD, PhD. “Medical evidence supports the surgical treatment of FAI and limiting access to this option would interfere with patient choice and the physician-patient relationship.”

Additionally, Andrea S. Herzka, MD, who was appointed by the commission as an Oregon-based orthopaedic expert reviewer to provide guidance on the issue, stated, “It is critical that the HERC revise its coverage recommendation in order to be consistent with the other evidence-based coverage determinations and provide access to this safe, effective, and cost-effective treatment to Oregon’s public employees and Oregon Health Plan participants.”



Elizabeth Fassbender, (202) 548-4143,


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