Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU Health Science Center, New Orleans, LA.
Pain Management Centers of America, Paducah, KY.
Pain Physician. 2021 Jan;24(1):1-15.
Despite epidurals being one of the most common interventional pain procedures for managing chronic spinal pain in the United States, expenditure analysis lacks assessment in correlation with utilization patterns.
This investigation was undertaken to assess expenditures for epidural procedures in the fee-for-service (FFS) Medicare population from 2009 to 2018.
The present study was designed to assess expenditures in all settings, for all providers in the FFS Medicare population from 2009 to 2018 in the United States. In this manuscript: • A patient was described as receiving epidural procedures throughout the year.• A visit was considered to include all regions treated during the visit. • An episode was considered as one treatment per region utilizing primary codes only.• Services or procedures were considered as all procedures including bilateral and multiple levels. A standard 5% national sample of the Centers for Medicare and Medicaid Services (CMS) physician outpatient billing claims data for those enrolled in the FFS Medicare program from 2009 to 2018 was utilized. All the expenditures were presented with allowed costs and adjusted to inflation to 2018 US dollars.
Total expenditures were $723,981,594 in 2009, whereas expenditures of 2018 were $829,987,636, with an overall 14.6% increase, or an annual increase of 1.5%. However, the inflation-adjusted rate was $847,058,465 in 2009, compared to $829,987,636 in 2018, a reduction overall of 2% and an annual reduction of 0.2%. Inflation-adjusted per patient annual costs decreased from $988.93 in 2009 to $819.27 in 2018 with a decrease of 17.2% or an annual decline of 2.1%. In addition, inflation-adjusted costs per procedure decreased from $399.77 to $377.94, or 5.5% overall and 0.6% annually. Per procedure, episode, visit, and patient expenses were higher for transforaminal epidural procedures than lumbar interlaminar/caudal epidural procedures. Overall, costs of transforaminal epidurals increased 27.6% or 2.7% annually, whereas lumbar interlaminar and caudal epidural injections cost were reduced 2.7%, or 0.3% annually. Inflation-adjusted costs for transforaminal epidurals increased 9.1% or 1.0% annually and declined 16.9 or 2.0% annually for lumbar interlaminar and caudal epidural injections.
Expenditures for epidural procedures in chronic spinal pain were assessed only in the FFS Medicare population. This excluded over 30% of the Medicare population, which is enrolled in Medicare Advantage plans.
After adjusting for inflation, there was a decrease of expenditures for epidural procedures of 2%, or 0.2% annually, from 2009 to 2018. However, prior to inflation, the increases were noted at 14.6% and 1.5%. Inflation-adjusted costs per patient, per visit, and per procedure also declined. The proportion of Medicare patients per 100,000 receiving epidural procedures decreased 9.1%, or 1.1% annually. However, assessment of individual procedures showed higher costs for transforaminal epidural procedures compared to lumbar interlaminar and caudal epidural procedures.
尽管硬膜外麻醉是美国管理慢性脊柱疼痛最常见的介入性疼痛程序之一，但支出分析缺乏与利用模式相关的评估。
本研究旨在评估 2009 年至 2018 年在医疗保险按服务项目付费（FFS）人群中进行硬膜外程序的支出。
本研究旨在评估 2009 年至 2018 年美国 FFS 医疗保险人群中所有提供者在所有环境中的支出。在本手稿中：• 患者被描述为在一年中接受硬膜外程序。• 就诊被认为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使用主要代码进行一次治疗。• 服务或程序被认为是包括双侧和多个水平的所有程序。利用医疗保险和医疗补助服务中心（CMS）2009 年至 2018 年 FFS 医疗保险计划参与者的全国 5%标准抽样门诊计费数据。所有支出均以允许成本呈现，并根据通胀调整至 2018 年美元。
2009 年总支出为 72398.154 万美元，而 2018 年支出为 829987636 万美元，总体增长 14.6%，或每年增长 1.5%。然而，经通胀调整后的利率为 2009 年的 847058465 美元，而 2018 年为 829987636 美元，总体下降 2%，年降幅为 0.2%。经通胀调整后的每位患者年成本从 2009 年的 988.93 美元降至 2018 年的 819.27 美元，降幅为 17.2%，年降幅为 2.1%。此外，经通胀调整后的每次程序成本从 399.77 美元降至 377.94 美元，或总体下降 5.5%，每年下降 0.6%。每次程序、发作、就诊和患者费用对于经椎间孔硬膜外程序高于腰椎间硬膜外/尾骨硬膜外程序。总体而言，经椎间孔硬膜外程序的成本增加了 27.6%，即每年增加 2.7%，而腰椎间硬膜外和尾骨硬膜外注射的成本减少了 2.7%，即每年减少 0.3%。经通胀调整的经椎间孔硬膜外程序成本每年增加 9.1%，即每年增加 1.0%，而腰椎间硬膜外和尾骨硬膜外注射的成本每年下降 16.9%或每年下降 2.0%。
仅在 FFS 医疗保险人群中评估了慢性脊柱疼痛的硬膜外程序支出。这排除了 30%以上参加医疗保险优势计划的 Medicare 人群。
经通胀调整后，2009 年至 2018 年硬膜外程序支出下降 2%，即每年下降 0.2%。然而，在通胀之前，增幅为 14.6%和 1.5%。经通胀调整后的每位患者、每次就诊和每次程序的成本也有所下降。每 10 万 Medicare 患者接受硬膜外程序的比例下降了 9.1%，即每年下降 1.1%。然而，对个别程序的评估显示，经椎间孔硬膜外程序的成本高于腰椎间硬膜外和尾骨硬膜外程序。
