1. 2023;26;207-217Effect of Provider Specialty on Medical Resource Utilization and Costs in Chronic Spinal-Pain Management
   Retrospective Analysis
   Peter S. Staats, MD, Ricardo Vallejo, MD, PhD, Nicolas C. Gasquet, MPH, and Christine N. Ricker, MA.

BACKGROUND: Poorly managed chronic spinal pain encumbers medical resources and drives healthcare costs, suggesting a target for improvement.

OBJECTIVES: To determine how specialist-care pathways influence healthcare costs in the first year after a referral for chronic spine pain.

STUDY DESIGN: This was a retrospective cohort analysis of administrative claims from a large commercial health insurance provider, analyzing a 6-month baseline, a variable “pre-referral period,” and a one-year period of specialist care.

SETTING: US patients covered by private commercial insurers.

METHODS: Adult patients diagnosed with chronic, spine-related pain between July 2016 and February 2018 and under the active care of a specialist were eligible. Patients with neurological deficits or cancer-related pain were excluded. Patients were categorized based on sequence-dependent exposure to a pain specialist, a surgeon, or both specialties. Key measures were pain-related and all-cause medical resource use and costs and opioid prescription fills.

RESULTS: Of 306,080 eligible patients (mean age 61.6; 61.5% women), 13% saw a pain specialist, 71% a surgeon, 7% a pain specialist then a surgeon, and 9% a surgeon then a pain specialist. Referral to a pain specialist alone was associated with lower resource use and per-patient adjusted cost savings of $3,311 (pain-related) and $6,447 (all-cause) compared to patients referred to a surgeon alone. The pain specialist pathway was associated with increased indicators of prescription opioid use.

LIMITATIONS: Cohort design constraints temper the results’ generalizability, given the need to simultaneously examine specialty pathway and medical resource incurred over the same time period.

CONCLUSIONS: We observed meaningful savings in cost and resource use when chronic spine-pain patients were managed by pain specialists. Pain-management referrals should be an element of a thoughtfully designed care pathway.

KEY WORDS: Chronic spinal pain, pain management, care pathway, spine surgery