1. 2024;27;455-467Exponential Decline of 28.9% in Utilization of Interventional Pain Management Techniques Among Medicare Beneficiaries From 2019 to 2022: Updated Analysis on the Ongoing Effects of COVID-19, Economic Decline, the Affordable Care Act (ACA), and Medical Poli
   Health Policy Research
   Laxmaiah Manchikanti, MD, Vidyasagar Pampati, MSc, Mahendra R. Sanapati, MD, Devi E. Nampiaparampil, MD, Nebojsa Nick Knezevic, MD, PhD, Alan D. Kaye, MD, PhD, Amol Soin, MD, Christopher G. Gharibo, MD, Alaa Abd-Elsayed, MD, and Joshua A. Hirsch, MD.

BACKGROUND: Numerous studies have highlighted the escalating costs associated with managing low back and neck pain, as well as other musculoskeletal disorders. In the past, there was a notable increase in the use of interventional techniques to address these disorders. However, the COVID-19 pandemic disrupted various chronic pain treatment approaches, including interventional procedures and opioid use, following a broader trend of reduced healthcare services. Consequently, there was an 18.7% decline in the use of interventional techniques per 100,000 Medicare beneficiaries between 2019 and 2020, a stark contrast to the previous growth patterns, despite some initial declines observed starting in 2017.

OBJECTIVES: This analysis aims to provide an updated evaluation of the utilization of interventional techniques for chronic pain management in the U.S. Medicare population.

STUDY DESIGN: A retrospective cohort study examining utilization patterns and factors affecting interventional techniques for chronic pain management in the FFS Medicare population in the United States from 2000 to 2022.

METHODS: Data for this analysis was obtained from the Centers for Medicare & Medicaid Services (CMS) master database, specifically the physician/supplier procedure summary, spanning the years 2000 to 2022.

RESULTS: This retrospective cohort study found that the rate of interventional pain management services per 100,000 Medicare beneficiaries showed a cumulative decline between 2019 and 2022 of 28.9%, with an annual decrease of 10.7%. This contrasts sharply with the 2010-2019 period, which saw a small annual decline of 0.4%. Particularly significant was the sharp reduction of 18.7% from 2019 to 2020, coinciding with the pandemic. From 2020 to 2021, the decline slowed to 1.1%, before accelerating again with an 11.5% drop between 2021 and 2022.  

LIMITATIONS: Data were available only through 2022 and were limited to the FFS Medicare population; utilization patterns for Medicare Advantage Plans, which accounted for nearly 50% of Medicare enrollment in 2022, were not included. Additionally, this analysis shares the inherent limitations of all retrospective reviews based on claims data.

CONCLUSION: This retrospective analysis demonstrates a significant reduction in the use of interventional pain management techniques from 2019 to 2022. Contributing factors to this decline likely include the lasting effects of COVID-19, economic challenges, the Affordable Care Act (ACA), and evolving local coverage determination policies.

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, economic decline, Affordable Care Act (ACA)