1. 2016;19;E531-E546Utilization of Interventional Techniques in Managing Chronic Pain In Medicare Population from 2000 to 2014: An Analysis of Patterns of Utilization
   Health Policy
   Laxmaiah Manchikanti, MD, Vidyasagar Pampati, MSc, and Joshua A. Hirsch, MD.

BACKGROUND: The increase in the utilization of various techniques in managing chronic pain, including interventional techniques, is a major concern for policy-makers and the public at large. Consequently, multiple regulations have been instituted to reduce health care expenditures in general and expenditures related to interventional techniques in particular. Previous investigations have shown significant increases of utilization of interventional techniques across the board with minor decreases noted in 2007, 2010, 2012 and 2013.

OBJECTIVE: To assess the patterns of utilization of interventional techniques in chronic pain management in the fee-for-service (FFS) Medicare population.

STUDY DESIGN: Analysis of utilization patterns of interventional techniques from 2000 to 2014 in Fee-for-Services (FFS) Medicare beneficiaries in managing chronic pain.

METHODS: The analyzed data was derived from the Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary Master Data from 2000 to 2014.

RESULTS: The analysis of data from 2000 to 2014 in FFS Medicare beneficiaries showed overall utilization of interventional techniques increasing at a rate of 153% and an annual average growth rate of 6.9% per 100,000 Medicare population with increase in services of 242%. This showed a 3% decrease per 100,000 Medicare population, compared to the data from 2000 through 2013, even though services increased by 6% due to the increase in the number of Medicare recipients in the FFS beneficiary group. The overall increases in epidural and adhesiolysis procedures were 165% with a rate of 96% per 100,000 Medicare population with an average annual increase of 4.9%. Facet joint interventions and sacroiliac joint blocks increased at a rate of 313% per 100,000 population with an annual average increase of 10.7%. Disc procedures and other types of nerve blocks increased at a much lesser pace than epidural and adhesiolysis procedures or facet joint interventions with an increase of 54% per 100,000 Medicare population and annual increase of 3.1%. A decrease in utilization was noted in 5 of 14 years ranging from 1.2% to 3.8%.

LIMITATIONS: The limitations of this updated utilization patterns of interventional techniques in managing chronic pain are multiple with lack of inclusion of participants from Medicare Advantage Plans, lack of complete and accurate data for statewide utilization, and potential errors in coding, billing, and documentation.

CONCLUSION: This overall analysis of patterns of utilization in managing chronic pain with interventional techniques showed a continued and significant increase in FFS Medicare beneficiaries from 2000 to 2014 with an increase of 153% per 100,000 Medicare population and at a rate of 6.9% on average per year. However, there were decreases of 2.9% in 2007, 3.8% in 2010, and 1.3%, 3.4%, and 1.2% from 2012 to 2014.

Key words: Interventional pain management, chronic spinal pain, interventional techniques, epidural injections, adhesiolysis, facet joint interventions, sacroiliac joint injections, disc procedures, other types of nerve blocks