Trends of Expenditures and Utilization of Facet Joint Interventions in Fee-For-Service (FFS) Medicare Population from 2009-2018

Abstract

Background: The trends of the expenditures of facet joint interventions have not been specifically assessed in the fee-for-service (FFS) Medicare population since 2009 Objectives: The objective of this investigation is to assess trends of expenditures and utilization of facet joint interventions in FFS Medicare population from 2009 to 2018. Study Design: The study was designed to analyze trends of expenditures and utilization of facet joint interventions in FFS Medicare population from 2009-2018 in the United States. In this manuscript: • A patient was considered as undergoing facet joint interventions throughout the year. • A visit included all regions treated during the visit. • An episode was considered as one per region utilizing primary codes only. • Services or procedures were considered all procedures (multiple levels). Data for the analysis was obtained from the standard 5% national sample of the Centers for Medicare & Medicaid Services (CMS) physician outpatient billing claims for those enrolled in the FFS Medicare program from 2009 to 2018. All the expenditures were presented with allowed costs and also were inflation adjusted to 2018 US dollars. Results: This analysis showed expenditures increased by 79% from 2009 to 2018 in the form of total cost for facet joint interventions, at an annual rate of 6.7%. Cervical and lumbar radiofrequency neurotomy procedures increased 185% and 169%. However, inflation-adjusted expenditures with 2018 US dollars showed an overall increase of 53% with an annual increase of 4.9%. In addition, using inflation-adjusted expenditures per procedures increased, the overall 6% with an annual increase of 0.7%. Overall, per patient costs, with inflation adjustment, decreased from $1,925 to $1,785 with a decline of 7% and an annual decline of 0.8%. Allowed charges per visit also declined after inflation adjustment from $951.76 to $849.86 with an overall decline of 11% and an annual decline of 1.3%. Staged episodes of radiofrequency neurotomy were performed in 23.9% of patients and more than 2 episodes for radiofrequency neurotomy in 6.9%, in lumbar spine and 19.6% staged and 5.1% more than 2 episodes in cervical spine of patients in 2018. Limitations: This analysis is limited by inclusion of only the FFS Medicare population, without adding utilization patterns of Medicare Advantage plans, which constitutes almost 30% of the Medicare population. Conclusions: Even after adjusting for inflation, there was a significant increase for the expenditures of facet joint interventions with an overall 53% increase. Costs per patient and cost per visit declined. Inflation-adjusted cost per year declined 7% overall and 0.8% annually from $1,925 to $1,785, and inflation-adjusted cost per visit also declined 11% annually and 1.3% per year from $952 in 2009 to $850 in 2018. Key words: Facet joint interventions, facet joint nerve blocks, facet joint neurolysis, facet joint injections, Medicare expenditures

Spinal Cord Stimulation Trends of Utilization and Expenditures in Fee-For-Service (FFS) Medicare Population from 2009 to 2018

“…C C hronic pain is a prevalent chronic disease with negative impact on the quality of life and function, with impact not only on individuals, but on families, communities, businesses, and health systems (1)(2)(3)(4)(5)(6)(7)(8)(9). The impact of chronic pain, of which spinal pain is the leading cause, is not only enormous, but also disproportionate in growth and expenditures (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

“…C C hronic pain is a prevalent chronic disease with negative impact on the quality of life and function, with impact not only on individuals, but on families, communities, businesses, and health systems (1)(2)(3)(4)(5)(6)(7)(8)(9). The impact of chronic pain, of which spinal pain is the leading cause, is not only enormous, but also disproportionate in growth and expenditures (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). This has been reinforced in multiple manuscripts and studies of the economic impact on health care in the United States, showing an estimated spending of $134.5 billion in 2016, with a 53.5% increase from 2013 of $87.6 billion spent for managing spinal pain alone.…”

“…National health expenditures (10) are continuing to grow at an average annual rate of 5.4% from 2019 to 2028 and to represent 19.7% of the gross domestic product by the end of the period. Medicare is growing much faster due to the graying of America (1)(2)(3)(4)6,10). In addition, health care expenditures have been escalating and the financial impact on the US economy is growing with a perfect storm created by COVID-19, the opioid epidemic and growth in expenditures and utilization patterns often of pain procedures (1)(2)(3)(4).…”

“…Medicare is growing much faster due to the graying of America (1)(2)(3)(4)6,10). In addition, health care expenditures have been escalating and the financial impact on the US economy is growing with a perfect storm created by COVID-19, the opioid epidemic and growth in expenditures and utilization patterns often of pain procedures (1)(2)(3)(4). Even though the COVID-19 epidemic resulted in severe access deficits for patients as well as undertreatment and a lack of treatment for elective care in 2020, growth patterns are expected to resume by 2022 (36,37).…”

“…Utilization of pharmacological and nonpharmacological modalities including surgical and nonsurgical interventions have been escalating for the treatment of chronic pain, specifically spinal pain including interventional techniques and surgical interventions, despite the decline noted for some interventions (1)(2)(3)(4)(38)(39)(40)(41)(42). Among these, surgical interventions and interventional techniques also have increased with an associated failure rate over the years (1)(2)(3)(4)(38)(39)(40)(41)(42).…”