Comparative Analysis of Utilization of Epidural Procedures in Managing Chronic Pain in the Medicare Population: Pre and Post Affordable Care Act

Spine
Laxmaiah ManchikantiJoshua A Hirsch

Abstract

A retrospective cohort study of utilization patterns of epidural injections. The aim of this study was to assess patterns of utilization and variables of in chronic spinal pain in the fee-for-service (FFS) Medicare population, with a comparative analysis of pre- and post-Affordable Care Act (ACA) data from 2000 to 2009 and 2009 to 2016. Over the years, utilization of interventional pain management techniques, specifically epidural injections have increased creating concern over costs and public health policy. The master data from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2016 was utilized to assess utilization patterns. The descriptive analysis of the database analysis was performed using guidance from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Multiple variables were analyzed based on the procedures, specialties, and geography. Caudal and lumbar interlaminar epidural injections decreased 25% from 2009 to 2016 with an annual decrease of 4% in contrast to lumbosacral transforaminal epidural injection episodes, increasing at an annual rate of 0.3%. In contrast, lumbar interlaminar epidural injections increased 2.4% annually, while t...Continue Reading

References

Dec 1, 2007·Epidemiology·Jan P VandenbrouckeUNKNOWN STROBE Initiative
May 28, 2008·Archives of Physical Medicine and Rehabilitation·Janna FriedlyCharles Maynard
Feb 12, 2011·Spine·Sean S RajaeeRick B Delamarter
Nov 1, 2012·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·John MacVicarNikolai Bogduk
Jan 31, 2013·Annals of Internal Medicine·Rafael Zambelli PintoPaulo H Ferreira
Jul 12, 2013·JAMA : the Journal of the American Medical Association·Christopher J L MurrayUNKNOWN U.S. Burden of Disease Collaborators
Nov 5, 2013·The Spine Journal : Official Journal of the North American Spine Society·William C PannellMichael D Daubs
Jan 15, 2014·The Spine Journal : Official Journal of the North American Spine Society·Ruth A LewisClare Wilkinson
Feb 12, 2014·Clinical Orthopaedics and Related Research·Laxmaiah ManchikantiJoshua A Hirsch
Mar 29, 2014·Pain Practice : the Official Journal of World Institute of Pain·Laxmaiah ManchikantiGabor B Racz
Jul 10, 2014·JAMA : the Journal of the American Medical Association·Andrew MooreEija Kalso
Jan 20, 2015·The Spine Journal : Official Journal of the North American Spine Society·Richard A Deyo
Mar 7, 2015·Journal of Neurointerventional Surgery·Joshua A HirschLaxmaiah Manchikanti
Mar 20, 2015·Anesthesiology and Pain Medicine·Laxmaiah ManchikantiJoshua Hirsch
Apr 2, 2015·Journal of Neurointerventional Surgery·Joshua A HirschLaxmaiah Manchikanti
Jul 30, 2015·Journal of Neurointerventional Surgery·Joshua A HirschLaxmaiah Manchikanti
Jan 30, 2016·AJNR. American Journal of Neuroradiology·J A HirschL Manchikanti
Mar 5, 2016·JAMA : the Journal of the American Medical Association·Howard Bauchner, Phil B Fontanarosa
Mar 18, 2016·MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports·Deborah DowellRoger Chou
Jul 12, 2016·JAMA : the Journal of the American Medical Association·Howard Bauchner
Jul 12, 2016·JAMA : the Journal of the American Medical Association·Barack Obama
Sep 24, 2016·AJNR. American Journal of Neuroradiology·J A HirschL Manchikanti
Nov 2, 2016·Journal of Neurointerventional Surgery·Joshua A HirschLaxmaiah Manchikanti
Dec 28, 2016·JAMA : the Journal of the American Medical Association·Joseph L DielemanChristopher J L Murray
Oct 20, 2017·JAMA : the Journal of the American Medical Association·Deborah DowellDebra Houry
Nov 9, 2017·JAMA : the Journal of the American Medical Association·Patrick H Conway
Nov 9, 2017·JAMA : the Journal of the American Medical Association·Joseph L DielemanChristopher J L Murray
Dec 5, 2017·International Journal of Medical Sciences·Laxmaiah ManchikantiJoshua A Hirsch
Dec 7, 2017·Health Affairs·Micah Hartman The National Health Expenditure Accounts Team

❮ Previous
Next ❯

Citations

Feb 19, 2020·Current Pain and Headache Reports·Ivan UritsOmar Viswanath
Nov 11, 2019·Current Pain and Headache Reports·Lei ZhaoAlaa Abd-Elsayed
Apr 24, 2020·Current Pain and Headache Reports·Riki PatelOmar Viswanath
Jul 1, 2020·Current Pain and Headache Reports·Annemarie GalassoOmar Viswanath
Jun 9, 2020·Current Pain and Headache Reports·John WolfOmar Viswanath
Apr 27, 2020·Current Pain and Headache Reports·Laxmaiah ManchikantiJoshua A Hirsch
Feb 1, 2020·Current Pain and Headache Reports·Laxmaiah ManchikantiJoshua A Hirsch
Mar 22, 2020·Current Pain and Headache Reports·Dylan HoytOmar Viswanath
Aug 14, 2020·Current Pain and Headache Reports·Morgan HasegawaOmar Viswanath
Jun 13, 2020·Current Pain and Headache Reports·Ivan UritsOmar Viswanath
Sep 24, 2020·AJR. American Journal of Roentgenology·Austin FletcherAmbarish P Bhat
Jul 16, 2021·The Clinical Journal of Pain·Steven P CohenDmitri Lissin

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.