Reversal of Growth of Utilization of Interventional Techniques in Managing Chronic Pain in
Medicare Population Post Affordable Care Act
Authors: Manchikanti, Laxmaiah 
Published: February 2021

Background: Over the past 2 decades, the increase in the utilization of interventional techniques
has been a cause for concern. Despite multiple regulations to reduce utilization of interventional
techniques, growth patterns continued through 2009.
A declining trend was observed in a previous evaluation; however, a comparative analysis of
utilization patterns of interventional techniques has not been performed showing utilization before
and after the enactment of the Affordable Care Act (ACA).
Objectives: Our aim is to assess patterns of utilization and variables of interventional techniques
in chronic pain management in the fee-for-service (FFS) Medicare population, with a comparative
analysis of pre- and post-ACA.
Study Design: Utilization patterns and variables of interventional techniques were assessed from
2000 to 2009 and from 2009 to 2016 in the FFS Medicare population of the United States in
managing chronic pain.
Methods: The master data from the Centers for Medicare & Medicaid Services (CMS) physician/
supplier procedure summary from 2000 to 2016 was utilized to assess overall utilization and
comparative utilization at various time periods.
Results: The analysis of Medicare data from 2000 to 2016 showed an overall decrease in utilization
of interventional techniques 0.6% per year from 2009 to 2016, whereas from 2000 to 2009, there
was an increase of 11.8% per year per 100,000 individuals of the Medicare population. In addition,
the United States experienced an increase of 0.7% per year of population growth, 3.2% of those
65 years or older and a 3% annual increase in Medicare participation from 2009 to 2016. Further
analysis also showed a 1.7% annual decrease in the rate of utilization of epidural and adhesiolysis
procedures per 100,000 individuals of the Medicare population, with a 2.2% decrease for disc
procedures and other types of nerve blocks, whereas there was an increase of 0.8% annually for
facet joint interventions and sacroiliac joint blocks from 2009 to 2016. Epidural and adhesiolysis
procedures showed an 8.9% annual increase, facet joint interventions and sacroiliac joint blocks
showed a 17.6% increase, and disc procedures and other types of nerve blocks showed a 7.2%
increase annually per 100,000 individuals of the Medicare population from 2000 to 2009.
Limitations: The limitations of this assessment include lack of analysis of individual procedures.
Additional limitations include lack of inclusion of patients from Medicare Advantage plans and lack
of complete and accurate data for statewide utilization.
Conclusion: From 2009 to 2016, interventional techniques decreased at an annual rate of 0.6%
with an overall decrease of 3.9%, compared to an overall increase of 173.6% from 2000 to 2009
with an annual increase of 11.8%. An additional analysis of data with individual procedures is
essential to gain further insights into utilization patterns.
Key words: Interventional pain management, chronic spinal pain, interventional techniques,
epidural injections, adhesiolysis, facet joint interventions, sacroiliac joint injections, disc procedures,
other types of nerve blocks