Retrospective analysis of Medicare data
To analyze trends of vertebral augmentation in the elderly Medicare population in the context of evolving evidence and varied medical society opinions.
Percutaneous vertebral augmentation offers a minimally invasive therapy for vertebral compression fractures. Numerous trials have been published on this topic with mixed results. The impact of these studies and societal recommendations on physician practice patterns is not well understood.
The Centers for Medicare and Medicaid Services annual Medicare Physician Supplier Procedure Summary database was examined for kyphoplasty and vertebroplasty procedures from 2005 through 2015. Top provider specialties were determined based on annual procedural volume, and grouped into the three broad categories of radiology, surgery, and anesthesia/pain medicine. Data entries were independently analyzed by provider type, site of service, submitted charges, and reimbursement rates for interventions during the study period.
Between 2005 and 2015 total annual claims for vertebral augmentation procedures in the Medicare population increased from 108.11% (37,133–77,276) peaking in 2008 and declining by 15.56% in 2009. Radiology is the largest provider of vertebral augmentation by specialty with declining market shares from 71% in 2005 to 43% in 2015. The frequency of vertebroplasty declined by 61.7% (35,409–13,478) from 2005 to 2015 with reduction in Medicare reimbursement. Annual volume of kyphoplasty grew by 18.3% (48,725–57,646) with significant increase in reimbursement for office-based procedures ($728.50/yr, P < 0.001, R 2 = 0.69).
The annual volume of vertebral augmentation declined in 2009 following two negative trials on vertebroplasty. Although these publications had a persistent negative impact on practice of vertebroplasty, the overall frequency of vertebral augmentation in the Medicare population has not changed significantly between 2005 and 2015. Instead, there has been a significant shift in provider practice patterns in favor of kyphoplasty in increasingly outpatient and office-based settings.
Level of Evidence: 3
∗Department of Radiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
†Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, Chicago, IL
‡Department of Radiology, Centegra Hospital, McHenry, IL
§Department of Radiology, University of Chicago, Chicago, IL.
Address correspondence and reprint requests to Osman Ahmed, MD, Department of Radiology, Section of Interventional Radiology, Rush University Medical Center, 1725W. Harrison St, Suite 450, Chicago, IL 60612; E-mail: email@example.com
Received 22 February, 2018
Revised 2 May, 2018
Accepted 11 June, 2018
The manuscript submitted does not contain information about medical device(s)/drug(s).
No funds were received in support of this work.
Relevant financial activities outside the submitted work: board membership, grants, payment for lecture.