Issue: February 2012
February 01, 2012
2 min read

Small percentage of providers perform most interventional spine procedures

Issue: February 2012
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According to an award-winning study, a minority of providers perform a disproportionately high percentage of interventional spine procedures, with neurologists and pain management specialists topping the list.

“Although some variation in the utilization of procedures exists across specialties, a consistent pattern of marked overutilization by a minority of providers is the most dominant characteristic of overutilization within all specialties,” Zachary Abbott, DO, of Olympia, Wash., said during his presentation at the 2011 Annual Meeting of the North American Spine Society. Abbott and colleagues won The Spine Journal Outstanding Paper award for their research.

The increased scrutiny of health care providers over the rising medical costs in the United States lead Abbott and colleagues to conduct their study to determine which specialties perform the highest number of interventional spinal procedures. According to Abbott, Medicare has calculated overuse by its providers; however, no one had determined the overuse of spinal procedures for privately insured patients.

“[A Medicare] analysis of one specific high-utilization area showed that 3.4% of physicians accounted for 43% of all injections performed,” for example, Abbott said.

Analysis of privately insured

Abbott and colleagues examined health care claims records using the Medstat MarketScan database of 12 million to 14 million privately insured Americans. They included adult patients who underwent epidural steroid or facet injections, medial branch blocks, radiofrequency neurotomies, sacroiliac joint injections and discographies between 2003 and 2007. Exclusion criteria consisted of patients lacking at least 12 months of claims records, the absence of a designated provider specialty code and specialties that performed less than 1% of all spinal procedures evaluated.

“We differentiated between the discography data, as discography is purely a diagnostic procedure, and the other procedures, which have some therapeutic benefit,” Abbott said. For discography, “we looked at the mean number of procedures per patient within and across specialties,” he said.

The most use

The investigators compared the mean number of therapeutic procedures per patient “within and across specialties,” with anesthesiologists, physiatrists, family practice physicians, orthopedists, radiologists, neurologists, internal medicine physicians, neurosurgeons and pain management specialists comprising the nine specialties responsible for nearly all of the spinal procedures studied.

Based on the results, during a 12-month period, the average number of procedures per patient was 4.46. On the high end, neurologists and pain management specialists performed an average of 4.8 procedures per patient per year. On the low end, radiologists performed an average of 2.3 procedures per patient per year. Per year, the top 10% of all providers performed an average of nine procedures per patient whereas the lowest 10% of providers performed one procedure per patient.

By adding the number of procedures per specialty, researchers found that the highest-utilizing 10% of providers, who exceeded five procedures per patient annually for the study period, performed 36.6% of all the spinal procedures done, and the top 20% of providers performed 57.6% of all procedures.

“Relatively few providers are responsible for a disproportionately high percentage of interventional spine procedures,” Abbott said.

He noted, “Efforts to abate overutilization will be most effective if they scrutinize the practices of individuals, regardless of specialty, who are responsible for a disproportionately high number of spinal interventions.” – by Renee Blisard

  • Abbott Z, Nair K, Allen R, et al. Utilization characteristics of spinal interventions. Presented at the 2011 Annual Meeting of the North American Spine Society. Nov. 2-5. Chicago.
  • Zachary Abbott, DO, can be reached at 404 Yauger Way SW, Olympia, WA 98592; 360-786-8990; email:
  • Disclosure: Abbott has no relevant financial disclosures.