Trends in Spinal Orthosis Utilization Among Patients Insured through Medicare Part B

Abstract

Study Design. Retrospective population-based database analysis from the Physician/Supplier Procedure Summary Medicare/Medicaid Dataset. Objective. To provide a comprehensive analysis of trends in spinal orthosis utilization over a 12-year period. Summary of Background Data. Widespread prescription of spinal orthosis persists, despite evidence suggesting equivocal efficacy in many spinal conditions. The utilization of spinal orthosis on a national level, including prescribing specialty data, has not been previously analyzed. Methods. Healthcare common procedure coding system (HCPCS) codes for cervical (CO), thoracic-lumbar-sacral (TLSO), lumbar (LO), lumbar-sacral (LSO), and cervical-thoracic-lumbar-sacral (CTLSO) orthosis were used to determine spinal orthosis utilization from 2010 to 2021. Provider specialty codes were utilized to compare trends between select specialties. Additionally, a neurosurgical CO analysis, based on subclassifications of cervical bracing, was performed. Linear trendlines were implemented to elucidate and present trends by slope (β). Results. Among 332,241 claims, decreases in CO (β=−0.3387), TLSO (β=−0.0942), LO (β=−0.3485), and LSO (β=−0.1545) per 100,000 Medicare Part B enrollees and CTLSO (β=−0.052) per 1,000,000 Medicare Part B enrollees were observed. Decreases among neurosurgery (β=−7.9208), family medicine (β=−1.0097), emergency medicine (β=−2.1958), internal medicine (β=−1.1151), interventional pain management (β=−5.0945), and chiropractic medicine (β=−49.012), and increases among orthopedic surgery (β=5.5891), pain management (β=30.416), physical medicine and rehabilitation (β=4.6524), general practice (β=79.111), and osteopathic manipulative medicine (β=45.303) in total spinal orthosis use per 100,000 specialty claims were observed. Analysis on subclassifications of cervical orthosis among neurosurgeons revealed decreases in flexible (β=−1.7641), semi-rigid (β=−0.6157), and collar bracing (β=−2.7603), and an increase in multi-post collar bracing (β=2.2032) per 100 neurosurgical cervical orthosis claims. Conclusions. While utilization of spinal orthosis decreased between 2010-2021, increased utilization was observed among a subset of specialties. Identifying these specialties allows for focused research and educational efforts to minimize unnecessary durable medical equipment use for effective healthcare spending.