2020 年 COVID-19 大流行导致 Medicare 人群中慢性疼痛管理的介入技术使用率降低 18.7%：2000 年至 2020 年利用数据分析。
COVID-19 Pandemic Reduced Utilization Of Interventional Techniques 18.7% In Managing Chronic Pain In The Medicare Population In 2020: Analysis Of Utilization Data From 2000 To 2020.
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. 2022 May;25(3):223-238.
BACKGROUND
Multiple publications have shown the significant impact of the COVID-19 pandemic on US healthcare and increasing costs over the recent years in managing low back and neck pain as well as other musculoskeletal disorders. The COVID-19 pandemic has affected many modalities of treatments, including those related to chronic pain management, including both interventional techniques and opioids. While there have not been assessments of utilization of interventional techniques specific to the ongoing COVID-19 pandemic, previous analysis published with data from 2000 to 2018 demonstrated a decline in utilization of interventional techniques from 2009 to 2018 of 6.7%, with an annual decline of 0.8% per 100,000 fee-for-service (FFS) in the Medicare population. During that same time, the Medicare population has grown by 3% annually.
OBJECTIVES
The objectives of this analysis include an evaluation of the impact of the COVID-19 pandemic, as well as an updated assessment of the utilization of interventional techniques in managing chronic pain in the Medicare population from 2010 to 2019, 2010 to 2020, and 2019 to 2020 in the FFS Medicare population of the United States.
STUDY DESIGN
Utilization patterns and variables of interventional techniques with the impact of the COVID-19 pandemic in managing chronic pain were assessed from 2000 to 2020 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 2020.
RESULTS
The results of the present investigation revealed an 18.7% decrease in utilization of all interventional techniques per 100,000 Medicare beneficiaries from 2019 to 2020, with a 19% decrease for epidural and adhesiolysis procedures, a 17.5% decrease for facet joint interventions and sacroiliac joint blocks, and a 25.4% decrease for disc procedures and other types of nerve blocks. The results differed from 2000 to 2010 with an annualized increase of 10.2% per 100,000 Medicare population compared to an annualized decrease of 0.4% from 2010 to 2019, and a 2.5% decrease from 2010 to 2020 for all interventional techniques. For epidural and adhesiolysis procedures decreases were more significant and annualized at 3.1% from 2010 to 2019, increasing the decline to 4.8% from 2010 to 2020. For facet joint interventions and sacroiliac joint blocks, the reversal of growth patterns was observed but maintained at an annualized rate increase of 2.1% from 2010 to 2019, which changed to a decrease of 0.01% from 2010 to 2020. Disc procedures and other types of nerve blocks showed similar patterns as epidurals with an 0.8% annualized reduction from 2010 to 2019, which was further reduced to 3.6% from 2010 to 2020 due to COVID-19.
LIMITATIONS
Data for the COVID-19 pandemic impact were available only for 2019 and 2020 and only the FFS Medicare population was utilized; utilization patterns in Medicare Advantage Plans, which constitutes almost 40% of the Medicare enrollment in 2020 were not available. Moreover, this analysis shares the limitations present in all retrospective reviews of claims based datasets.
CONCLUSION
The decline driven by the COVID-19 pandemic was 18.7% from 2019 to 2020. Overall decline in utilization in interventional techniques from 2010 to 2020 was 22.0% per 100,000 Medicare population, with an annual diminution of 2.5%, despite an increase in the population rate of 3.3% annualized (38.9% overall) and Medicare enrollees of 33.4% and 2.9% annually.
背景
多项出版物表明，COVID-19 大流行对美国医疗保健系统产生了重大影响，近年来管理下腰痛和颈痛以及其他肌肉骨骼疾病的成本不断增加。COVID-19 大流行影响了许多治疗方式，包括与慢性疼痛管理相关的治疗方式，包括介入技术和阿片类药物。虽然尚未评估针对当前 COVID-19 大流行的介入技术的使用情况，但之前发表的一项基于 2000 年至 2018 年数据的分析显示，从 2009 年至 2018 年，介入技术的使用量下降了 6.7%，在 Medicare 人群中，每 10 万服务收费（FFS）每年下降 0.8%。在此期间，Medicare 人群的增长率为每年 3%。
目的
本分析的目的包括评估 COVID-19 大流行的影响，以及评估 2010 年至 2019 年、2010 年至 2020 年和 2019 年至 2020 年 Medicare 人群中介入技术在管理慢性疼痛方面的利用情况在美国 FFS Medicare 人群中。
研究设计
从 2000 年至 2020 年，在美国 FFS Medicare 人群中评估介入技术的利用模式和变量以及 COVID-19 大流行对慢性疼痛管理的影响。
方法
分析的数据来自 2000 年至 2020 年 Medicare 和 Medicaid 服务中心（CMS）医生/供应商程序摘要的主数据库。
结果
本研究结果显示，2019 年至 2020 年，每 10 万 Medicare 受益人的所有介入技术的使用率下降了 18.7%，硬膜外和粘连松解术下降了 19%，关节突关节介入和骶髂关节阻滞下降了 17.5%，椎间盘手术和其他类型的神经阻滞下降了 25.4%。与 2000 年至 2010 年相比，结果有所不同，与 2010 年至 2019 年相比，每年每 10 万 Medicare 人群增加 10.2%，与 2010 年至 2019 年相比，每年减少 0.4%，与 2010 年至 2020 年相比，所有介入技术减少 2.5%。硬膜外和粘连松解术的下降更为显著，与 2010 年至 2019 年相比，每年下降 3.1%，与 2010 年至 2020 年相比，下降 4.8%。关节突关节介入和骶髂关节阻滞的增长模式发生了逆转，但仍保持每年增加 2.1%，与 2010 年至 2019 年相比，这一比例从 2010 年至 2020 年下降了 0.01%。椎间盘手术和其他类型的神经阻滞与硬膜外类似，与 2010 年至 2019 年相比，每年减少 0.8%，由于 COVID-19，这一比例进一步减少到 2010 年至 2020 年的 3.6%。
局限性
COVID-19 大流行影响的数据仅可用于 2019 年和 2020 年，仅使用了 FFS Medicare 人群；2020 年 Medicare 优势计划（占 Medicare 参保人数的近 40%）的利用模式不可用。此外，本分析与所有基于索赔的数据集的回顾性审查存在的局限性相同。
结论
COVID-19 大流行导致的下降为 2019 年至 2020 年的 18.7%。从 2010 年至 2020 年，介入技术的总体使用量下降了 22.0%，每 10 万 Medicare 人群每年减少 2.5%，尽管人口增长率为每年 3.3%（总体增长率为 38.9%），Medicare 参保人数每年增加 33.4%和 2.9%。
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