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
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
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: email@example.com.
- Disclosure: Abbott has no relevant financial disclosures.