Percutaneous Adhesiolysis Procedures in the Medicare Population: Analysis of Utilization and Growth Patterns from 2000 to 2011

Abstract

Background: Multiple reviews have shown that interventional techniques for chronic pain have increased dramatically over the years. Of these interventional techniques, both sacroiliac joint injections and facet joint interventions showed explosive growth, followed by epidural procedures. Percutaneous adhesiolysis procedures have not been assessed for their utilization patterns separately from epidural injections. Study Design: An analysis of the utilization patterns of percutaneous adhesiolysis procedures in managing chronic low back pain in the Medicare population from 2000 to 2011. Objective: To assess the utilization and growth patterns of percutaneous adhesiolysis in managing chronic low back pain. Methods: The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master of Fee-For-Service (FFS) Data from 2000 to 2011. Results: Percutaneous adhesiolysis procedures increased 47% with an annual growth rate of 3.6% in the FFS Medicare population from 2000 to 2011. These growth rates are significantly lower than the growth rates for sacroiliac joint injections (331%), facet joint interventions (308%), and epidural injections (130%), but substantially lower than lumbar transforaminal injections (665%) and lumbar facet joint neurolysis (544%). Limitations: Study limitations include lack of inclusion of Medicare Advantage patients. In addition, the statewide data is based on claims which may include the contiguous or other states. Conclusion: Percutaneous adhesiolysis utilization increased moderately in Medicare beneficiaries from 2000 to 2011. Overall, there was an increase of 47% in the utilization of adhesiolysis procedures per 100,000 Medicare beneficiaries, with an annual geometric average increase of 3.6%. Key words: Interventional techniques, chronic spinal pain, epidural steroid injections, percutaneous adhesiolysis, post surgery syndrome, spinal stenosis

The Influence of Covid-19 on Utilization of Epidural Procedures in Managing Chronic Spinal Pain in the Medicare Population

“…A more recent publication3 has shown a significant impact of the COVID-19 pandemic, with a 19% decrease in epidural and adhesiolysis procedures per 100,000 FFS Medicare beneficiaries. The previous analysis showed significant decreases in utilization patterns of epidural adhesiolysis procedures of an annual decrease of 12.3% and vertebral augmentation procedures with an annual decrease of 2.5% per 100,000 Medicare population from 2009 to 2018 29,32…”

“…Previous evaluations of utilization patterns of epidural procedures have shown significant increases until 2009, with an annual increase of 7.3% from 2000 to 2009 per 100,000 fee-for-service (FFS) Medicare population, followed by a decline at a rate of 2.5% annually from 2009 to 2018 25,26,29,30. These annual declines were 4.7% for lumbar interlaminar epidural injections and cervical transforaminal epidural injections, followed by 1.1% for lumbar transforaminal epidurals and 0.4% for cervical interlaminar epidural injections.…”

“…Consequently, over the years, multiple changes have been made in the delivery of health care with increasing regulations and oversight, which have resulted in declining utilization and potentially curtailing access to medically necessary treatments, including epidural procedures. 3,[25][26][27][28][29][30][31][32] These studies have shown a deceleration of opioid-related deaths up until 2019, with an escalation in 2020, despite continued reductions in the utilization of opioids, and the number of prescriptions and dosages showed a rapid decline. 9,10 This has led to descriptions of the opioid paradox.…”

“…Previously published data of US spending on personal and public health care23,24 showed the highest spending outlay for back and neck pain, increasing 53.5% from the total 2013 cost of $87.6 billion to a cost of $134.5 billion in 2016. Consequently, over the years, multiple changes have been made in the delivery of health care with increasing regulations and oversight, which have resulted in declining utilization and potentially curtailing access to medically necessary treatments, including epidural procedures 3,25–32. These studies have shown a deceleration of opioid-related deaths up until 2019, with an escalation in 2020, despite continued reductions in the utilization of opioids, and the number of prescriptions and dosages showed a rapid decline 9,10.…”

“…The previous analysis showed significant decreases in utilization patterns of epidural adhesiolysis procedures of an annual decrease of 12.3% and vertebral augmentation procedures with an annual decrease of 2.5% per 100,000 Medicare population from 2009 to 2018. 29,32 Over the years, literature has provided discordant conclusions of the clinical and cost-utility of epidural procedures, even though extensive literature, including systematic reviews, randomized controlled trials, cost-utility analysis, and guidelines, have shown appropriate evidence. Discordant conclusions are based on the lack of agreement between proponents and opponents of the effectiveness and indications, with proponents emphasizing inappropriate conclusions as the basis of discordant results.…”