Explosive growth of facet joints interventions in the Medicare population of the United States: a comparative evaluation of data from 1997, 2002 and 2006 (2024)

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Abstract

Background

Office of Inspector General (OIG) for the Department of Health and Human Services (OIG-DHHS), issued a report in September 2008 [1] Note that Medicare paid more than $ 2 billion in 2006 for procedures for intervention pain (IPM).Concept, 63% of the Facet joint injection services that Medicare allowed in 2006, has not paid, which results in around $ 129 million in incorrect payments.This report illustrated that facet joint injection services that were delivered in an office had an error rather than it delivered in an outpatient surgical center (ASC) or Hospital-Polikline department (HOPD).OIG report also illustrated that 35% of the Medicare Facet-LEDin projections were carried out by non-interventional pain.2-5].

Friedly et al [3,,6] Assessed trends in injection procedures that mainly focus on epidural injections from 1994 to 2001. Manchikanti et al [[[[[[[[[[[2]] Analyzed the growth of all intervention techniques for dealing with chronic pain in Medicare recipients from 1997 to 2006. Both researchers showed a uniform increase in intervention techniques in all environment and in all parts of the country.-Services per100,000 from Medicare recipients were 137% with a total increase in IPM services with 197% per year.100,000 Medicare recipients who increased by 197 %.100,000 Medicare recipients.

Chronic spinal cord pain in the United States is very widespread with a significant economic impact [7-16].However, the treatment of spinal pain is controversial, partly related to broad variability in the treatments used [16].7] .Freburger et al [7] showed an annual increase of 11.6% of the chronic low back pain and attributed a significant part of the rising costs of low back pain in the past 2 decades to this increasing occurrence.Economic effects, especially in the elderly [10-13,,17,,18].

Epidural injections and facet joint Interventions are the 2 most used procedures in IPM [1-6,,19,,20]. Inimidtid is the literature that relates to the effectiveness of Facet Fute Interventions, although the new, very varied, based on technology, outcome goals, selection of patients and methodology [21-28].

Health care expenditure in the United States escalating and the long -term tax -durability of Medicare is in question [26-29] .I a report entitledAccounting for the costs of American health care: a new view of why Americans use more[[30] It was established that the United States spent $ 650 billion more on health care in 2006 than its Peer Organization for Economic Cooperation and Development (OECD), even after adaptation to wealth.Of the means to control health care costs, it is to ensure that all care is medically necessary and avoid excessive use, abuse and fraud.

In this study we tried to evaluate the use of all types of facet joint interventions (ie intra -articular injections, facet -go -gone nerve blocks and faceted neurotomy) in lumbar, cervical and thorax spinal column.In the number of procedures, reimbursem*nt, involvement of specialties, use of fluoroscopy and indications.Finally, we tried to explore the relationship between the total injection costs and the amount of services that are provided in HOPD institutions, ACSS and at the office.

Methods

The data for this study was used from the standard 5% national sample of the outpatient clinic of the CMS doctor for 1997, 2002 and 2006. The data set is a sample of those registered in the Fee-For-Service Medicare program onbased on Deing elections.For researchers.Moreover, a data set of 100% is that it is not possible to use for research purposes.Or publication.

Earlier research [3,,6] In general patients aged 65 and older.2].Overall Medicare registered more than 43 million beneficiaries in 2006 and is the largest payer for health care in the United States [31] Of course, the Medicare -data set contains a large part of the spinal cord pain procedures that are performed in the United States, including Facet -Mell -Interventions.International classification of diseases, 9^EAuditing, clinical adjustment (ICD-9-cm) diagnostic codes;Date of service, provider, specialty of the provider, zip code and permitted reimbursem*nts.

To provide data for the entire recipient population of Medicare, the results of the 5% test were multiplied by 20. In addition, the rates were calculated on the basis of Medicare recipients for the corresponding year and reported per year.100,000 medicare recepers.The data was tabled based on the Service Site - ASC of Office for the years 1997, 2002 and 2006. Facility costs were also identified for Hopds, ASCs and offices (office facility facilities).Hopd was estimated on the basis of based on national payment rates taking into account modificators due to the lack of accessibility of HOPD data in the data set.Fees were used to estimate the costs of Medicare for these procedures and the costs were adjusted for inflation in health Care for the use of the USA or Labor Statistics Consumer Price Index (CPI) for medical care services and represents theCosts for 2006 [[32].

In this study, all types of facet connections interventions with CPT -codes 64470, 64472, 64475, 64476, 64622, 64623, 64626 and 64627 with evaluation of Medicare data from 1997, 2002 and 2006.

In addition, diagnostic codes were used from ICD-9-cm. The previous studies excluded coherent interventions in cervicals and thorax facets [3,,6];They claimed that cervicals and thorax spine disorders differ clinically from lumbar spilling and can be the result of various disease processes.So it felt important to record these interventions.

To analyze the data based on specialty, the IPM specialties were described as the providers designated in IPM -09, Pain Medicine -72, Anesthesiology -05, Physical Medicine and Rehabilitation -25, Neurology -13, Psychiatry -26, orthopedic surgery -20, and neurosurgery -14 [[33].Generelle practitioners -01, family -practitioners -08 and internists -11 were considered general doctors.

Result

Common growth pattern

FigureDabbleIllustrates the total growth pattern for Facet Fute interventions.These annual increased rates for Facet design interventions represent the years from 1997 to 2006. There was an increase in the facet joint interventions of general doctors of more than 1,109%.

discussion

Facet joint intervention percentages for disorders of the spinal cord rose dramatically during the research period from 1997 to 2006. This increase per year.100,000 Medicare of 1997 to 2006 was relatively constant over time, which resulted in an increase in facet milking patients with 386%, facet joint visits of 446%and facet common interventions of 543%.Facet common interventions also increased based on age.100,000, less than 65 years old, compared to these 65 years or older, increased the patient population, which received facet joint interventions, 504% against 355%, visited 587% compared to 404%,And the services rose 683% compared to 498%.Moreover, they also rose.Joint interventions by General Doctors- compiled from general practice, family practice and internal medicine- from 2002 to 2006, an annual increase of 277.3%.Increase of 99.5%.

There was a 26.8 times difference in the exploitation pattern in Florida from Hawaii, the state with the lowest pattern voor 2006. The remaining 49 states showed less than a 10 times difference.growth of facet joint interventions in office settings of 271% with ASC settings showing the growth and HOPD entries showing 40% growth.To move procedures tilted tilted Het Probleem, Aangezien The Meaning Kosten Van De Total Procedure In Hopd Installation In2006 $ 467.80 Waren, Terwijl Het Up Kantoor $ 227.60 Was an in ASC instant Was Het $ 352.20.

The use of fluoroscopy was the lowest among families and general practices and internal medicine doctors and the highest among specialties of pain management.

With regard to proof of Facet design interventions, there is new evidence to show the effectiveness of medial branching blocks and radio frequency -neurotomy, together with effective diagnosis when patients are correctly met indications and medical necessity criteria [[20-28]. People this proof emerges, there are some systematic assessments [19] these tests did not use [26-28] in their evidence of synthesis.

Friedly et al [3] Postulated, Bij There was a disproportionate Steken in procedures in ACSs, and BIJ ACSS received higher bets Bij Increase revenue voor practice at Bij Receive Facility Payments Voor Procedures.Medische Productie.

Based on the current data, it seems that the annual increase in the population with chronic low back pain is 11.6% [[7], and the increase in facet communal intervention visits is approximately.50%.34,,35] .Kucky showed an annual increase of 25% and Indiana, 26%;While the annual increase in Florida was 95%.

McKinsey Global Institute [30] has posted various factors for the increased growth in outpatient health care in the United States.Firstly, in this study the capacity growth of care providers and the response to high outpatient margins are illustrated on the basis of a significant increase in the number of in-office and the implementation of these procedures that more efficient services are provided in outpatient settings as a result of specialized staffand equipment, location, short waiting times and a better doctors output [34,,35]. The other factor relates to the verdict based on the nature of medical care. In the course of the years there has been significant growth in intervention pain due to increased understanding and availability of a supply of doctors. The third factor described relates totechnological innovation that stimulates de prijzen hoger in plaats van stock [36], Which has not been proven in this study in the Medicare Movement in the USA. The fourth factor relates to the aftermath of question, which looks like there there is there there there there is there there there.Bende and also the rising Voorkeken of spinal cord pain.Prijbevberiliging is niet van toepassing.Out-of-Pocket-of-Pocket Cost Illustrator Deze Verschillen.

There are various limitations for our studies.This includes the lack of admission of participants in Medicare Advantage plans, including approximately. 10% of the registrations and potential coding errors [3,,31However,a higher frequency.van Diensten.Over the algae ontving Patiënten Jonger Dan 65 Intensie Ein Grotes Deel Van de Diensten (504% Tegen 355%) [2] .This Knowledge is repeated in this evaluation showing a Steken in FACET Joint Services of 683% against 498% from 1997 to 2006. Since Datee did not contain HOPD system departures, we had to schatter the facility fees voor policlinesse an aal [3]. A other restriction is, a certain variatie may be related to coding errors and diagnostic ambiguity and to non-reporting of fluoroscopy. Due to the brown of actual geven Weinig invloed.

More recommendations have been made to slow down the growth of health costs in general and in particular intervention techniques [1,,4,,36].1] have recommended to strengthen the program efforts to prevent incorrect payments;3] also recommended stricter rules for medical necessity, indications, accreditation provisions in the institutions and training and qualifications for doctors who perform the procedures.

Conclusion

Finally, our data summarizes the explosive growth of Facet -Joint -interventions together in accordance with the OIG report [1] and other reports [2This overview also shows that growth has been considerable in certain regions and with certain specialisms.Part of the growth can be explained by the improved access, the accuracy of the diagnostic and therapeutic modality results and the increasing prevalence of spinal cord pain.There are even more problems with the lack of clarity in the diagnosis, the lack of use of fluoroscopy, the disproportionate increase in the number of procedures in some specialties and some regions, and the rising costs.

Competing interests

Dr.Kikant is CEO and chairman of the American Society of Interventional Pain Physician, representing intervention pain doctors across the country; is the medical director of Paducah's Paducah's Pain Management, Ambulatory Surgery Center of Paducah and Smercce Surgery, which provides interventional pain handling services, including facet -Interventions in one Poliklinisch surgelisch center an in one Kantooromge wing;An is Universitair Hoofdocent Anesthesiology Aan de Universiteit van Louisville.

Dhr.pampati is a statistician and used in Pach -Center Paduch.He is a non -docking and does not perform intervention techniques;

Dr.Singh is the medical director of Pain Diagnostic Associates, Niagara, Wisconsin.He is a doctor for intervention pain management who practices in an outpatient surgical center and in the policy departments of the hospital, including Facet joint interventions.

Dr.boswell is professor of Anesthesiology and director of the International Pain Center, Texas Tech University Health Sciences Center, Lubbock, Texas.

Dr.Smith is an assistant professor and academic director of Pain Management for Albany Medical College Department of Anesthesiology, Albany, New York.

Dr. Hirschis head of minimally invasive spine surgery with the radiology and neurosurgery departments, Massachusetts General Hospital;Felt interventions.

The author's contribution

LM, VP, VS, MVB, HSS en JAH Finking Concept, Design and Cooking. manuscript.

History for publication

The story for publication for this article can be obtained here:

http://www.biomedcentral.com/1472-6963/10/84/prepub

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Acknowledgment

The authors want to thank Sekar Edem for his help with the literature research and Tonie M. Hatton and Diane E. Neihoff, transcriptionists, for their help in preparing this manuscript.

References