Open AccessAn Updated Assessment of Utilization of Interventional Pain Management Techniques in the Medicare Population: 2000 – 2013
Author(s) -
Laxmaiah Manchikanti,
Vidyasagar Pampati,
Frank J E Falco,
Joshua A Hirsch
Publication year - 2015
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/2015.18.e115
Subject(s) - medicine , utilization management , chronic pain , interventional pain management , psychological intervention , medicaid , population , health care , modalities , medicare advantage , reimbursement , family medicine , physical therapy , emergency medicine , environmental health , nursing , social science , sociology , economics , economic growth
Background: The rapid increase in the prevalence of chronic pain and disability, and the explosion ofinterventional pain management associated health care costs are a major concern for our community.Further, the increasing utilization of numerous modalities of treatments in managing chronic pain,continue to escalate at a pace which may not be sustainable. There are multiple regulations in place tocontrol the growth of health care expenditures which seem to have been largely ineffective. Amongthe various modalities utilized in managing chronic pain, interventional techniques have shown asignificant increase in their utilization in the face of continued debate with respect to the accuracy ofdiagnostic interventions and the efficacy of therapeutic interventions.Objective: To update and assess the utilization of interventional techniques in chronic painmanagement in fee-for-service Medicare population.Study Design: An updated analysis of the growth of interventional techniques in managing chronicpain in fee-for-service Medicare beneficiaries from 2000 through 2013.Methods: The data were derived and analyzed utilizing the Centers for Medicare and MedicaidServices (CMS) Physician Supplier Procedure Summary Master Data from 2000 through 2013.Results: From 2000 through 2013, in fee-for-service Medicare beneficiaries, the overall utilizationof interventional techniques services increased 236% at an annual average growth of 9.8%, whereasthe per 100,000 Medicare population utilization increased 156% with an annual average growthof 7.5%. During this period, the US population increased 12% with an annual average increase of0.9%, whereas those above 65 years of age increased 27% with an annual average increase of 1.9%.Total Medicare beneficiaries increased 31% with an annual average increase of 2.1%, with an overallincrease of 64% for those above 65 years of age, an increase of 26%, constituting 17% of the USpopulation in 2013.The overall increases in epidural and adhesiolysis procedures were 165% compared to 102% per100,000 fee-for-service population with annual average increases of 7.8% and 5.6%. Facet jointand sacroiliac joint injections increased 417% for services with an annual average increase of 13.5%,whereas the rate per 100,000 fee-for-service Medicare beneficiaries increased 295% with an annualaverage increase of 11.1%.Limitations: Limitations of this assessment include the lack of inclusion of participants fromMedicare Advantage plans, lack of appropriate available data for state-wide utilization, and potentialerrors in documentation, coding, and billing.Conclusion: This update once again shows a significant increase in interventional techniques in feefor-service Medicare beneficiaries from 2000 through 2013 with an increase of 156% per 100,000Medicare population with an annual average increase of 7.5%. During this period the Medicarepopulation increased 31% with an annual average increase of 2.1%.Key words: Chronic pain, chronic spinal pain, interventional pain management, interventionaltechniques, epidural injections, facet joint interventions, sacroiliac joint injections