1. 2013;16;E365-E378Assessment of the Escalating Growth of Facet Joint Interventions in the Medicare Population in the United States from 2000 to 2011
   Health Policy Review
   Vidyasagar Pampati, MSc, Laxmaiah Manchikanti, MD, Vijay Singh, MD, and Frank J.E. Falco, MD.

BACKGROUND: Both the Office of Inspector General (OIG) and reports from studies of the utilization of facet joint interventions have expressed that explosive increases in facet joint interventions provided to spinal pain patients are a major concern.

STUDY DESIGN: The study is designed to assess the growth of facet joint interventions in managing spinal chronic pain in Medicare beneficiaries from 2000 to 2011.

OBJECTIVE: To assess the use of facet joint interventions in chronic pain management.

METHODS: The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) physician supplier procedure summary master data from 2000 to 2011.

RESULTS: The utilization of all types of facet joint interventions increased enormously from 2000 to 2011, with an overall increase of 308% per 100,000 Medicare beneficiaries and a 13.6% average annual increase. In addition, the highest increases were seen for cervical/thoracic radiofrequency neurotomy with 836%, followed by an increase of 662% for lumbar/sacral radiofrequency neurotomy, a 359% increase in cervical/thoracic facet joint injections, and 228% increase in lumbosacral facet joint injections. In reference to the number of procedures performed, however, the highest numbers were in the lumbosacral region with 990,449 total procedures of lumbar facet joint blocks and 406,378 lumbosacral radiofreqency neurotomies in 2011. Cervical and thoracic facet joint nerve blocks were 317,220, whereas cervical and thoracic radiofrequency neurotomies were 97,526 in 2011.

The data also showed that there were enormous increases in the proportion of procedures performed by the specialty of physical medicine and rehabilitation, with an increase of 781% and an annual increase of 21.9% excluding physicians of physical medicine and rehabilitation enrolled as interventional pain management or pain management. Even though the numbers were very low for nurse anesthetists, nurse practitioners, and physician assistants, the increases were from 143 in 2000 to 21,263 in 2011, providing an annual increase of 55.2%, an overall increase of 12,460%.

LIMITATIONS: The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, as well as potential documentation, coding, and billing errors. Furthermore, the data provided for state utilizations is based on claims data for that state which also may include patients from contiguous or other states receiving services in those states.

CONCLUSIONS: The explosive increase in the number of lumbar facet joint interventions performed began to wane in 2008. From 2008 to 2010, the utilization of facet joint interventions declined by 6%.