Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.
University of Utah School of Medicine, Salt Lake City, UT.
Pain Physician. 2024 Sep;27(7):E687-E693.
Increasing enrollment in Medicare has coincided with reductions in reimbursement for various procedures, including interventional pain procedures. No previous analysis of state-to-state differences in Medicare reimbursement rates for practicing pain management physicians has been performed.
To quantify recent national and geographical trends for interventional pain procedures.
This study used datasets from the Centers for Medicare and Medicaid Services to identify the top 10 highest-grossing Current Procedure Terminology (CPT) codes for pain procedures and for evaluation and management (E/M) from 2014 to 2023. Data analysis took place during May 2023.
Primary outcomes were calculated inflation-adjusted rates of yearly percent change (YPC) for each CPT code, state, territory, and U.S. Census region. An independent samples t-test compared the national YPC rates of procedure to those of E/M reimbursement. Medicare reimbursements throughout the United States for interventional pain procedures and clinic evaluations were measured from 2014-2023.
From 2014 to 2023, inflation-adjusted Medicare reimbursement for interventional pain procedures decreased yearly by an average of 3.63%. In comparison, clinic evaluation reimbursement decreased by only 0.87% yearly and was significantly different from procedure reimbursement (P < 0.001). Pain management procedure reimbursement decreased the most in Illinois (-4.26%), Wyoming (-3.88%), Wisconsin (-3.87%), Nevada (-3.83%) and Kansas (-3.82%). Meanwhile, rates for Puerto Rico (-1.94%), Massachusetts (-3.24%), Washington (-3.31%), New York (-3.39%), and West Virginia (-3.47%) decreased the least. When states were grouped into U.S. Census regions, no significant regional differences in pain management procedure reimbursement changes could be observed.
Only the facility prices of the top 10 highest-grossing procedure and E/M CPT codes that had available data for 2014 to 2023 could be included in our analysis; trends for private insurance reimbursement could not be analyzed.
Medicare reimbursement rates for interventional pain procedures have decreased from 2014 to 2023, both nationally and in each region of the U.S. Our analysis suggests that certain states and territories have experienced less favorable reimbursement trends than others. This issue is worthy of attention as larger proportions of the U.S. population become eligible for Medicare coverage; should these trends continue, interventional pain physicians may consider moving their practices to areas that are less affected. Major efforts are required to preserve the quality of care that Medicare beneficiaries receive and to remedy the problem of depreciating reimbursement.
医疗保险参保人数的增加恰逢各种程序（包括介入性疼痛程序）的报销减少。以前没有对管理疼痛的医生的医疗保险报销率的州际差异进行过分析。
量化最近全国和地理上介入性疼痛程序的趋势。
本研究使用医疗保险和医疗补助服务中心的数据集，从 2014 年到 2023 年，确定疼痛程序和评估和管理 (E/M) 的前 10 个最高毛额当前程序术语 (CPT) 代码。数据分析于 2023 年 5 月进行。
主要结果是计算每个 CPT 代码、州、地区和美国人口普查区每年百分比变化 (YPC) 的通胀调整率。独立样本 t 检验比较了程序的全国 YPC 率与 E/M 报销率。从 2014 年到 2023 年，全美介入性疼痛程序和诊所评估的医疗保险报销情况进行了测量。
从 2014 年到 2023 年，介入性疼痛程序的医疗保险报销金额每年平均下降 3.63%。相比之下，诊所评估的报销金额仅每年下降 0.87%，与程序报销明显不同（P < 0.001）。伊利诺伊州（-4.26%）、怀俄明州（-3.88%）、威斯康星州（-3.87%）、内华达州（-3.83%）和堪萨斯州（-3.82%）的疼痛管理程序报销下降最多。与此同时，波多黎各（-1.94%）、马萨诸塞州（-3.24%）、华盛顿州（-3.31%）、纽约州（-3.39%）和西弗吉尼亚州（-3.47%）的降幅最小。当各州被分为美国人口普查区时，无法观察到疼痛管理程序报销变化的显著区域差异。
只有 2014 年至 2023 年有可用数据的前 10 个毛额最高的程序和 E/M CPT 代码的设施价格才能纳入我们的分析；无法分析私人保险报销的趋势。
从 2014 年到 2023 年，全国和美国每个地区的介入性疼痛程序的医疗保险报销率都有所下降。我们的分析表明，某些州和地区的报销趋势不如其他地区有利。随着美国更多的人口符合医疗保险的覆盖范围，这个问题值得关注；如果这些趋势继续下去，介入性疼痛医生可能会考虑将他们的业务转移到受影响较小的地区。需要做出重大努力来维护医疗保险受益人的护理质量，并解决报销贬值的问题。
