2000 年至 2018 年 Medicare 人群中慢性疼痛管理的介入技术应用的逆转和下降趋势更新。

Update on Reversal and Decline of Growth of Utilization of Interventional Techniques In Managing Chronic Pain in the Medicare Population from 2000 to 2018.

机构信息

Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU Health Science Center, New Orleans, LA.

Pain Management Centers of America, Evansville, IN.

出版信息

Pain Physician. 2019 Nov;22(6):521-536.

PMID:31775397

Abstract

BACKGROUND

The cost of US health care continues to increase, with treatments related to low back and neck pain and other musculoskeletal disorders accounting for the third highest amount of various disease categories. Interventional techniques for managing pain apart from conservative modalities and surgical interventions, have generally been thought to be growing rapidly. However, a recent analysis of utilization of interventional techniques from 2000 to 2016 has shown a modest decline from 2009 to 2016, compared to 2000 to 2009.

OBJECTIVES

The objectives of this analysis include providing an update on utilization of interventional techniques in managing chronic pain in the Medicare population from 2009 to 2018 in the fee-for-service (FFS) Medicare population of the United States.

STUDY DESIGN

Utilization patterns and variables of interventional techniques in managing chronic pain were assessed from 2000 to 2009 and from 2009 to 2018 in the FFS Medicare population of the United States.

METHODS

The data for the analysis was obtained from the master database from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2018. The analysis of data showed that there was a decline in utilization of interventional techniques from 2009 to 2018 of 6.7%, with an annual decline of 0.8% per 100,000 FFS Medicare population, despite an increase of 0.7% per year of population growth (3.2% of those 65 years or older) and a 3% annual increase in Medicare participation from 2009 to 2018. Medicare data from 2000 to 2009 showed an increase of 11.8% per year per 100,000 individuals of the Medicare population. The 2009 to 2018 data also showed a 2.6% annual decrease in the rate of utilization of epidural and adhesiolysis procedures per 100,000 population of FFS Medicare, and a 1% decrease for disc procedures and other types of nerve blocks, while there was an increase of 0.9% annually for facet joint interventions and sacroiliac joint blocks.

LIMITATIONS

Limitations of this analysis include: only the Medicare population was utilized, and among the Medicare population, only the FFS population was evaluated; utilization patterns in Medicare Advantage Plans, which constitutes almost 30% of the population were not considered. Further, the utilization data for individual states was sparse and may not be accurate.

CONCLUSION

The decline in utilization of interventional techniques continued from 2009 to 2018 with 6.7% per 100,000 Medicare population, with an annual decline of 0.8%, despite an increase in the population rate and Medicare enrollees of 0.7% and 3% annually.

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.

摘要

背景

美国医疗保健费用持续攀升，与下背部和颈部疼痛以及其他肌肉骨骼疾病相关的治疗费用占各类疾病类别中的第三位。除了保守治疗和手术干预之外，介入技术用于治疗疼痛，通常被认为正在迅速发展。然而，最近对 2000 年至 2016 年介入技术的使用情况进行的分析显示，与 2000 年至 2009 年相比，2009 年至 2016 年期间，这一比例略有下降。

目的

本分析的目的是提供在美国医疗保险服务（Medicare）按服务付费（FFS）人群中，2009 年至 2018 年间介入技术用于管理慢性疼痛的最新数据。

研究设计

在美国 FFS Medicare 人群中，评估了 2000 年至 2009 年和 2009 年至 2018 年介入技术治疗慢性疼痛的使用模式和变量。

方法

该分析的数据来自 2000 年至 2018 年医疗保险和医疗补助服务中心（CMS）医生/供应商程序汇总主数据库。数据分析显示，2009 年至 2018 年间，介入技术的使用率下降了 6.7%，按每 10 万 FFS Medicare 人群计算，每年下降 0.8%，尽管人口增长率每年增长 0.7%（65 岁及以上人口增长 3.2%），2009 年至 2018 年间 Medicare 参与率每年增长 3%。2000 年至 2009 年 Medicare 数据显示，每 10 万 Medicare 人群中，介入技术的使用每年增长 11.8%。2009 年至 2018 年的数据还显示，每 10 万 FFS Medicare 人群中，硬膜外和粘连松解术的使用率每年下降 2.6%，椎间盘手术和其他类型神经阻滞的使用率每年下降 1%，而关节突关节介入术和骶髂关节阻滞术的使用率每年增加 0.9%。