Declining Utilization Patterns of Percutaneous Adhesiolysis Procedures in the Fee-For-Service (FFS) Medicare...

Area of Science:

• Pain Management
• Interventional Pain Procedures
• Health Services Research

Background:

• Percutaneous epidural adhesiolysis is a minimally invasive treatment for chronic low back and lower extremity pain.
• Utilization increased until 2008 but has significantly declined in the Medicare population since 2009.

Purpose of the Study:

• To assess the utilization patterns of percutaneous adhesiolysis in the Medicare population.
• Analyze trends from 2000 to 2018, comparing pre- and post-2009 periods.

Main Methods:

• Analysis of Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master Fee-For-Service (FFS) Data from 2000-2018.
• Assessment of utilization patterns, growth/declining trends, specialty-based, and statewide utilization.

Main Results:

• A significant decline in percutaneous adhesiolysis procedures began in 2009.
• From 2009-2018, utilization declined by 69.2% annually at 12.3%, contrasting with a 62.6% increase (5.6% annually) from 2000-2009.
• This decline is more rapid compared to other interventions like epidural injections.

Conclusions:

• There is an irreversible decline in the utilization of percutaneous adhesiolysis in the US Medicare FFS population.
• The procedure's utilization has been steadily deteriorating since 2009.