Editor-in-Chief: Kenneth D. Candido, MD

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  1. IPM 2018;157-166 Usage Patterns of Sacroiliac Joint Injections - A Comparative Evaluation of Pre and Post Affordable Care Act In Medicare Population
    Brief Report
    Maanasa Manchikanti , Laxmaiah Manchikanti, MD, Alan D. Kaye, MD, PhD, Vidyasagar Pampati, MSc, and Joshua A. Hirsch, MD.

BACKGROUND: The sacroiliac joints (SIJ) have been implicated as highly prevalent, pervasive, expensive, causes of chronic low back pain. The utilization of SIJ injections is escalating. A recent analysis demonstrated a reversal of growth of utilization patterns of interventional techniques post passage of the Affordable Care Act (ACA). Bearing that in mind, SIJ injections along with facet joint interventions seem to have increased modestly in that same period.

STUDY DESIGN: Analysis of growth patterns of SIJ injections from 2000 to 2016 with comparative analysis of pre- and post- ACA.

OBJECTIVES: To assess utilization patterns of SIJ injections from 2000 to 2016.

METHODS: The Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master dataset was utilized in this analysis.

RESULTS: The results of the evaluation from 2000 to 2016 showed, 11.7% increase from 2009 to 2016, with an annual increase of 1.6% per 100,000 Medicare population compared to an increase of 299.8% from 2000 to 2009 with annual increase of 16.6%.

LIMITATIONS: The limitations of this study included a lack of inclusion of Medicare Advantage patients and the possibility that state claims data may include claims from other states.  As with all claims based data analyses, this study is retrospective and thus potentially limited by bias.  Finally, patients who are self or commercially insured are not part of the dataset.

CONCLUSIONS: Study shows dampened increase in utilization patterns of SIJ injections from 2009 to 2016 as compared with a like time period prior.

KEY WORDS: Chronic spinal pain, low back pain, sacroiliac joint arthritis, interventional techniques, interventional pain management, sacroiliac joint injections