McKay Monroe, Gorvine Margaret M, Zaller Nickolas, Singh Vinita, Goree Johnathan
University of Arkansas for Medical Sciences, College of Medicine, Little Rock, AR.
University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, Little Rock, AR.
Pain Physician. 2022 Dec;25(9):E1457-E1466.
With increased hospitalizations and deaths related to opioid use disorder, there is an impetus for federal and private insurance companies to provide coverage for integrative treatments that address pain. The Centers for Disease Control and Prevention (CDC) and the current literature recommend that nonpharmacological and nonopioid treatments must be considered for chronic pain management. The continued examination of potential coverage and cost-effectiveness for opioid-sparing alternatives with proven efficacy is critical for physicians who treat chronic pain.
Qualitative analysis of coverage policies for 10 alternative chronic back pain therapies was completed using the most up-to-date publicly available information from federal and state databases until September 2021.
To determine coverage for opioid-sparing treatments for chronic back pain across federal and state healthcare systems.
We selected the alternative therapies from the National Institute of Health's National Center for Complementary and Integrative Health (NCCIH) (www.nccih.nih.gov). We then collected and analyzed coverage policies for federal and state healthcare plans, including Medicare, Veterans Health Administration (VHA), Indian Health Services (IHS), and Medicaid, by accessing federal databases and state policy databases via the department of health and human services (HHS).
The 2 most commonly covered nonpharmacologic therapies for chronic back pain are physical therapy and cognitive behavioral therapy. Other more novel therapies have a heterogenous distribution among federal and state healthcare coverage. Assessment of regional differences determined that the median number of treatments in the Northeast and Midwest was 3, while in the South and West, it was 2.
Several provider manuals included varying degrees of information regarding their services. Some states included all pertinent information, such as the definition of treatment, the exact number of service visits allowed annually, and whether prior authorization was necessary. Many manuals provided less information than this. Each state's Medicaid document contained inherent variability, especially with respect to when they were updated or published. Some states had updated information available for 2021, while the most updated policies for other states included documents that were last updated in 2008.
Integrative treatments for chronic back pain are currently available, yet coverage varies widely depending on the patient's Medicare or Medicaid status. Different states cover different therapies, which may lead to unequal healthcare outcomes for patients with chronic pain.
随着与阿片类药物使用障碍相关的住院和死亡人数增加，联邦和私人保险公司有动力为解决疼痛问题的综合治疗提供保险。疾病控制与预防中心（CDC）和当前文献建议，慢性疼痛管理必须考虑非药物和非阿片类治疗。对于治疗慢性疼痛的医生而言，持续研究已证实有效的阿片类药物替代方案的潜在保险覆盖范围和成本效益至关重要。
利用截至2021年9月从联邦和州数据库获取的最新公开信息，对10种慢性背痛替代疗法的保险政策进行了定性分析。
确定联邦和州医疗系统中慢性背痛阿片类药物替代治疗的保险覆盖情况。
我们从美国国立卫生研究院的补充与综合健康国家中心（NCCIH）（www.nccih.nih.gov）中选择替代疗法。然后，通过卫生与公众服务部（HHS）访问联邦数据库和州政策数据库，收集并分析联邦和州医疗计划（包括医疗保险、退伍军人健康管理局（VHA）、印第安人健康服务局（IHS）和医疗补助）的保险政策。
慢性背痛最常涵盖的两种非药物疗法是物理治疗和认知行为疗法。其他更新颖的疗法在联邦和州医疗覆盖范围中的分布各异。区域差异评估确定，东北部和中西部的治疗中位数为3次，而南部和西部为2次。
几本提供者手册包含的关于其服务的信息程度不一。一些州包含了所有相关信息，如治疗的定义、每年允许的服务就诊确切次数以及是否需要事先授权。许多手册提供的信息比这少。每个州的医疗补助文件都存在内在差异，尤其是在更新或发布时间方面。一些州有2021年的更新信息，而其他州的最新政策包括最后更新于2008年的文件。
目前有慢性背痛的综合治疗方法，但保险覆盖范围因患者的医疗保险或医疗补助状况而有很大差异。不同的州覆盖不同的疗法，这可能导致慢性疼痛患者的医疗结果不平等。
