2009-2018 年按服务项目付费（FFS）的 Medicare 人群中关节突关节介入治疗的支出和利用趋势。

Trends of Expenditures and Utilization of Facet Joint Interventions in Fee-For-Service (FFS) Medicare Population from 2009-2018.

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, Paducah, KY.

出版信息

Pain Physician. 2020 May;23(3S):S129-S147.

PMID:32503360

Abstract

BACKGROUND

The trends of the expenditures of facet joint interventions have not been specifically assessed in the fee-for-service (FFS) Medicare population since 2009.

OBJECTIVE

The objective of this investigation is to assess trends of expenditures and utilization of facet joint interventions in FFS Medicare population from 2009 to 2018.

STUDY DESIGN

The study was designed to analyze trends of expenditures and utilization of facet joint interventions in FFS Medicare population from 2009-2018 in the United States. In this manuscript: • A patient was considered as undergoing facet joint interventions throughout the year. • A visit included all regions treated during the visit. • An episode was considered as one per region utilizing primary codes only. • Services or procedures were considered all procedures (multiple levels). Data for the analysis was obtained from the standard 5% national sample of the Centers for Medicare & Medicaid Services (CMS) physician outpatient billing claims for those enrolled in the FFS Medicare program from 2009 to 2018. All the expenditures were presented with allowed costs and also were inflation adjusted to 2018 US dollars.

RESULTS

This analysis showed expenditures increased by 79% from 2009 to 2018 in the form of total cost for facet joint interventions, at an annual rate of 6.7%. Cervical and lumbar radiofrequency neurotomy procedures increased 185% and 169%. However, inflation-adjusted expenditures with 2018 US dollars showed an overall increase of 53% with an annual increase of 4.9%. In addition, using inflation-adjusted expenditures per procedures increased, the overall 6% with an annual increase of 0.7%. Overall, per patient costs, with inflation adjustment, decreased from $1,925 to $1,785 with a decline of 7% and an annual decline of 0.8%. Allowed charges per visit also declined after inflation adjustment from $951.76 to $849.86 with an overall decline of 11% and an annual decline of 1.3%. Staged episodes of radiofrequency neurotomy were performed in 23.9% of patients and more than 2 episodes for radiofrequency neurotomy in 6.9%, in lumbar spine and 19.6% staged and 5.1% more than 2 episodes in cervical spine of patients in 2018.

LIMITATIONS

This analysis is limited by inclusion of only the FFS Medicare population, without adding utilization patterns of Medicare Advantage plans, which constitutes almost 30% of the Medicare population.

CONCLUSIONS

Even after adjusting for inflation, there was a significant increase for the expenditures of facet joint interventions with an overall 53% increase. Costs per patient and cost per visit declined. Inflation-adjusted cost per year declined 7% overall and 0.8% annually from $1,925 to $1,785, and inflation-adjusted cost per visit also declined 11% annually and 1.3% per year from $952 in 2009 to $850 in 2018.

KEY WORDS

Facet joint interventions, facet joint nerve blocks, facet joint neurolysis, facet joint injections, Medicare expenditures.

摘要

背景

自 2009 年以来，在按服务收费（FFS）的医疗保险人群中，尚未专门评估关节突关节介入治疗的支出趋势。

目的

本研究旨在评估 2009 年至 2018 年 FFS 医疗保险人群中关节突关节介入治疗的支出和利用趋势。

研究设计

本研究旨在分析 2009-2018 年美国 FFS 医疗保险人群中关节突关节介入治疗的支出和利用趋势。在本手稿中：

患者在全年内被视为接受关节突关节介入治疗。
就诊包括就诊期间治疗的所有区域。
一个发作被认为是每个区域仅使用主要代码的一次。
服务或程序被认为是所有程序（多个级别）。

分析数据来自美国医疗保险和医疗补助服务中心（CMS）标准 5%的全国样本，这些数据来自 2009 年至 2018 年参加 FFS 医疗保险计划的医生门诊计费索赔。所有支出均以允许的费用呈现，并根据 2018 年的美元进行了通胀调整。

结果

本分析显示，2009 年至 2018 年，关节突关节介入治疗的总成本增长了 79%，年增长率为 6.7%。颈椎和腰椎射频神经松解术分别增长了 185%和 169%。然而，以 2018 年美元计算的通胀调整后支出显示总体增长 53%，年增长率为 4.9%。此外，随着通胀调整后每例手术的支出增加，总体增长 6%，年增长率为 0.7%。总体而言，经通胀调整后的每位患者费用从 1925 美元降至 1785 美元，下降 7%，年下降 0.8%。经通胀调整后的每次就诊的允许费用也从 951.76 美元降至 849.86 美元，总体下降 11%，年下降 1.3%。2018 年，射频神经松解术有 23.9%的患者进行了分期发作，6.9%的患者进行了两次以上的射频神经松解术，19.6%的患者进行了颈椎分期发作，5.1%的患者进行了两次以上的颈椎发作。

局限性

本分析仅限于 FFS 医疗保险人群，不包括医疗保险优势计划的利用模式，医疗保险优势计划构成了近 30%的医疗保险人群。

结论

即使考虑到通胀因素，关节突关节介入治疗的支出也显著增加，总体增加了 53%。每位患者的成本和每次就诊的成本都有所下降。经通胀调整后的每年成本总体下降 7%，从 2009 年的 1925 美元降至 2018 年的 1785 美元，经通胀调整后的每次就诊费用也从 2009 年的 952 美元下降 11%，年下降 1.3%，至 2018 年的 850 美元。