1Department of Neurological Surgery, University of California, San Francisco, California.
2Washington Office, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Washington, DC.
J Neurosurg Spine. 2024 Sep 27;41(6):784-791. doi: 10.3171/2024.6.SPINE24311. Print 2024 Dec 1.
This study aimed to report changes in utilization and payment trends of low-back pain (LBP) interventions and the impact of nonsurgeon interventionalists on these changes.
Medicare Part B national summary data files were used to gather annual utilization and Centers for Medicare and Medicaid Services (CMS) payment data for LBP interventions from 2000 to 2021. Healthcare Common Procedure Coding System (HCPCS) codes were grouped as decompression, spinal fusion, sacroiliac (SI) joint fusion, epidural steroid injections (ESIs), physical therapy (PT), and chiropractic manipulation (Chiro). The total allowed services and payments were collected for each HCPCS group. CMS provider-level files, available from 2013 to 2021, were used to collect neurosurgeon, orthopedic surgeon, and nonsurgeon interventionalist (interventional radiology and pain management) data for each surgical HCPCS code group (decompression, spinal fusion, and SI joint fusion). The United States Consumer Price Index was used to adjust for inflation.
From 2000 to 2021, there were 339,720,725 Medicare-approved interventions and payments of approximately $21 billion for LBP (percentage of cumulative payments: 41.8% Chiro, 16.5% ESI, 14.4% spinal fusion, 14.3% PT, 10.2% decompression, and 0.4% SI joint fusion). In a subgroup analysis, spinal fusions for Medicare patients were performed by orthopedic surgeons (59.2%), neurosurgeons (40.6%), and nonsurgeon interventionalists (< 1%) from 2013 to 2021. From 2013 to 2021, neurosurgeon and orthopedic surgeon fusion utilization each grew by < 3% and associated Medicare payments to each specialty declined by 1% each year. During the same period, nonsurgeon interventionalist utilization grew 26% each year and associated Medicare payments to nonsurgeon interventionalists for spine fusions grew 62% each year. In a subgroup analysis, SI joint fusions for Medicare patients were performed by orthopedic surgeons (50.7%), neurosurgeons (24.8%), and nonsurgeon interventionalists (24.5%) from 2018 to 2021. Neurosurgeon utilization of SI joint fusion declined by 1% each year and associated Medicare payments to this group grew 2% each year. Orthopedic surgeon utilization of SI joint fusion declined 1% and associated Medicare payments to this group grew 4% each year. Nonsurgeon interventionalist use of SI joint fusions grew 415% and payments grew 435% each year.
The substantial growth in Medicare payments for surgical LBP interventions is disproportionally driven by nonsurgeon interventionalists. The exponential growth of nonsurgeon interventionalists performing spinal fusion surgeries, particularly SI joint fusions, largely accounts for the significant increase in Medicare expenditures.
本研究旨在报告下腰痛（LBP）干预措施的利用和支付趋势变化，以及非外科介入医师对这些变化的影响。
使用医疗保险 B 部分国家汇总数据文件，收集 2000 年至 2021 年 LBP 干预措施的年度利用和医疗保险和医疗补助服务中心（CMS）支付数据。医疗保健通用程序编码系统（HCPCS）代码分为减压、脊柱融合、骶髂（SI）关节融合、硬膜外类固醇注射（ESI）、物理治疗（PT）和脊椎按摩（Chiro）。为每个 HCPCS 组收集了总允许服务和付款。CMS 提供商级文件可从 2013 年到 2021 年获得，用于为每个手术 HCPCS 代码组（减压、脊柱融合和 SI 关节融合）收集神经外科医生、骨科医生和非外科介入医师（介入放射学和疼痛管理）的数据。使用美国消费者价格指数对通货膨胀进行调整。
从 2000 年到 2021 年，医疗保险批准的 LBP 干预措施约为 3397.20725 亿次，支付约 210 亿美元（累计支付的百分比：41.8% Chiropractic，16.5% ESI，14.4%脊柱融合，14.3% PT，10.2%减压和 0.4% SI 关节融合）。在亚组分析中，2013 年至 2021 年间，接受医疗保险的患者进行的脊柱融合术由骨科医生（59.2%）、神经外科医生（40.6%）和非外科介入医师（<1%）进行。从 2013 年到 2021 年，神经外科医生和骨科医生的融合利用率每年分别增长<3%，每个专业的医疗保险支付每年下降 1%。同期，非外科介入医师的利用率每年增长 26%，非外科介入医师对脊柱融合术的医疗保险支付每年增长 62%。在亚组分析中，2018 年至 2021 年间，接受医疗保险的患者的 SI 关节融合术由骨科医生（50.7%）、神经外科医生（24.8%）和非外科介入医师（24.5%）进行。神经外科医生进行 SI 关节融合术的利用率每年下降 1%，而向该组支付的医疗保险额每年增长 2%。骨科医生进行 SI 关节融合术的利用率下降 1%，向该组支付的医疗保险额每年增长 4%。非外科介入医师进行 SI 关节融合术的利用率增长 415%，支付额增长 435%。
医疗保险对手术性 LBP 干预措施的大量支付增长主要由非外科介入医师推动。非外科介入医师进行脊柱融合手术，特别是 SI 关节融合手术的指数级增长，在很大程度上导致了医疗保险支出的显著增加。
