Open AccessAnalysis of the Growth of Epidural Injections and Costs in the Medicare Population: A Comparative Evaluation of 1997, 2002, and 2006 Data
Author(s) -
Laxmaiah Manchikanti,
Vidyasagar Pampati,
Mark V. Boswell,
Howard S. Smith,
Joshua A Hirsch
Publication year - 2010
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2010/13/199
Subject(s) - medicine , reimbursement , population , lumbar , medicaid , interventional pain management , lumbosacral joint , specialty , medicare advantage , surgery , physical therapy , chronic pain , health care , family medicine , environmental health , economics , economic growth
Background: Interventional techniques for the treatment of spinal techniques are commonlyused and are increasing exponentially. Epidural injections and facet joint interventions arethe 2 most commonly utilized procedures in interventional pain management. The currentliterature regarding the effectiveness of epidural injections is sparse with highly variableoutcomes based on the technique, outcome measures, patient selection, and methodology.Multiple reports have illustrated the exponential growth of lumbosacral injections withsignificant geographic variations in the administration of epidural injections in Medicarepatients. However, an analysis of the growth of epidural injections and costs in the Medicarepopulation has not been performed with recent data and has not been looked at from aninterventional pain management perspective.Study Design: Analysis of epidural injection growth and costs in Medicare’s population1997, 2002, and 2006.Objectives: The primary purpose of this study was to evaluate the use of all types ofepidural injections (i.e. caudal, interlaminar, and transforaminal in lumbar, cervical andthoracic regions), and other epidural procedures, including epidural adhesiolysis. In addition,the purpose was to identify trends in the number of procedures, reimbursement, specialtyinvolvement, fluoroscopy use, and indications from 1997 to 2006.Methods: The Centers for Medicare and Medicaid Services (CMS) 5% national samplecarrier claim record data from 1997, 2002, and 2006 was utilized.Outcomes Assessment: Outcome measures included Medicare beneficiaries’characteristics receiving epidural injections, epidural injections by place of service, type ofspecialty, reimbursement characteristics, and other variables.Results: Epidural injections increased significantly in Medicare beneficiaries from 1997to 2006. Patients receiving epidurals increased by 106.3%; visits per 100,000 populationincreased 102.7%.Hospital outpatient department (HOPD) payments increased significantly; ASC averagepayments decreased; overall payments increased. The increase in procedures performed bygeneral physicians outpaced that of interventional pain management (IPM) physicians.Limitations: Study limitations include no Medicare Advantage patients; potentialdocumentation, coding, and billing errors.Conclusions: Epidural injections grew significantly. This growth appears to coincide withchronic low back pain growth and other treatments for low back pain. Since many proceduresare performed without fluoroscopy, continued growth and inappropriate provision of servicesmight reduce access.Key words: Epidural injections, interventional techniques, interventional pain management,chronic pain, ambulatory surgery center (ASC), hospital outpatient department (HOPD)