Comparative Analysis of Utilization of Epidural Procedures in Managing Chronic Pain in the Medicare Population: Pre and Post Affordable Care Act
| Autor: | Sanjay Bakshi, Joshua A Hirsch, Amol Soin, Laxmaiah Manchikanti, Vidyasagar Pampati, Dharam P Mann |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
MEDLINE Injections Epidural Medicare 03 medical and health sciences 0302 clinical medicine Patient Protection and Affordable Care Act medicine Health insurance Humans Pain Management Orthopedics and Sports Medicine Pre and post Retrospective Studies 030222 orthopedics business.industry Chronic pain Retrospective cohort study medicine.disease Spinal pain United States Back Pain Emergency medicine Medicare population Neurology (clinical) Chronic Pain business 030217 neurology & neurosurgery |
| Zdroj: | Spine. 44(3) |
| ISSN: | 1528-1159 |
| Popis: | A retrospective cohort study of utilization patterns of epidural injections.The aim of this study was to assess patterns of utilization and variables of in chronic spinal pain in the fee-for-service (FFS) Medicare population, with a comparative analysis of pre- and post-Affordable Care Act (ACA) data from 2000 to 2009 and 2009 to 2016.Over the years, utilization of interventional pain management techniques, specifically epidural injections have increased creating concern over costs and public health policy.The master data from the Centers for MedicareMedicaid Services (CMS) physician/supplier procedure summary from 2000 to 2016 was utilized to assess utilization patterns. The descriptive analysis of the database analysis was performed using guidance from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Multiple variables were analyzed based on the procedures, specialties, and geography.Caudal and lumbar interlaminar epidural injections decreased 25% from 2009 to 2016 with an annual decrease of 4% in contrast to lumbosacral transforaminal epidural injection episodes, increasing at an annual rate of 0.3%. In contrast, lumbar interlaminar epidural injections increased 2.4% annually, while transforaminal episodes increased 23% from 2000 to 2009. The ratio of interlaminar epidural injections to transforaminal epidural injection episodes has changed from 7 in 2000 to 1 in 2016, whereas ratio of services changed from 5 to 0.7. From 2009 to 2016, cervical/thoracic interlaminar epidural injections episodes increased at an annual rate of 0.5%, with a decrease of 2.3% for transforaminal epidural injections.Comparative analysis of the utilization of epidural injections from 2000 to 2009 and 2009 to 2016 showed vast differences with overall significant decreases in utilization, specifically for lumbar interlaminar and caudal epidural injections, with a continued, though greatly slowed increase of lumbosacral transforaminal epidural injections.3. |
| Databáze: | OpenAIRE |
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