03:18 PM Abstract No. 201 Changing trends in utilization and physician payments for vertebroplasty and kyphoplasty procedures among Medicare beneficiaries: 2010-2017

Abstract

To study and provide an update on utilization of vertebroplasty and kyphoplasty procedures among Medicare beneficiaries and analyze the changing trends in total volumes and payments by physician specialty for a recent eight-year period. Claims from the Medicare Part B Physician/Supplier Procedure Summary Master File (PSPSMF) for the years 2010 and 2017 were extracted using the CPT codes for vertebroplasty and kyphoplasty. Total volumes, payment amounts (professional component), and trends were analyzed by physician specialty. Between 2010 and 2017, the total volume of vertebroplasties decreased by 58.9% (29,995 to 12,344), while the volume of kyphoplasties increased modestly by 11.8% (59,691 to 66,730). Radiologists performed 20,546 (68.5%) vertebroplasties in 2010, which decreased to 9,515 (77.1%) in 2017. Similar trends were observed for orthopedic surgeons (3,101 to 612) and neurosurgeons (2,108 to 1,373). For kyphoplasty, radiologists performed 17,215 (28.9%) procedures in 2010, which increased to 24,231 (36.3%) in 2017, whereas orthopedic surgeons’ volume decreased from 21,645 to 16,513 and the volume for neurosurgery remained relatively stable at 13,704 to 13,950. Total payment for vertebroplasties decreased by 72.4% from $14.8 million in 2010 to $4.1 million in 2017; whereas it increased by 208.1% for kyphoplasty procedures from $26.7 million to $82.4 million. From 2010 to 2017, the average per-procedure payment decreased for vertebroplasty by 32.9% (from $493.7 to $331.3) but increased for kyphoplasty by 175.6% (from $448.1 to $1234.7). Average per-procedure amount was considerably higher for anesthesiologists and interventional pain management physicians ($547.5 for vertebroplasty and $2897.0 for kyphoplasty in 2017). Previous studies have demonstrated mixed evidence for the benefits of vertebroplasty procedures with decreasing volumes over time. While no causality can be determined by this observational study, the data shows a continued downtrend in vertebroplasty and increased utilization of kyphoplasty among Medicare beneficiaries. In addition, total and average per-procedure payment amount for kyphoplasty have increased considerably.