February 13, 2025 Newswires

Findings from Texas Technical University Yields New Findings on Managed Care (National and Geographic Trends In Medicare Reimbursement for Pain Management 2014-2023): Managed Care

Health Policy and Law Daily

2025 FEB 13 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Current study results on Managed Care have been published. According to news reporting originating from Lubbock, Texas, by NewsRx correspondents, research stated, “Increasing enrollment in Medicare has coincided with reductions in reimbursement for various procedures, including interventional pain procedures. No previous analysis of state-tostate differences in Medicare reimbursement rates for practicing pain management physicians has been performed.”

Our news editors obtained a quote from the research from Texas Technical University, “To quantify recent national and geographical trends for interventional pain procedures. This study used datasets from the Centers for Medicare and Medicaid Services to identify the top 10 highest-grossing Current Procedure Terminology (CPT) codes for pain procedures and for evaluation and management (E/M) from 2014 to 2023. Data analysis took place during May 2023. Primary outcomes were calculated inflation-adjusted rates of yearly percent change (YPC) for each CPT code, state, territory, and U.S. Census region. An independent samples t-test compared the national YPC rates of procedure to those of E/M reimbursement. Medicare reimbursements throughout the United States for interventional pain procedures and clinic evaluations were measured from 2014-2023. From 2014 to 2023, inflation-adjusted Medicare reimbursement for interventional pain procedures decreased yearly by an average of 3.63%. In comparison, clinic evaluation reimbursement decreased by only 0.87% yearly and was significantly different from procedure reimbursement (P < 0.001). Pain management procedure reimbursement decreased the most in Illinois (-4.26%), Wyoming (-3.88%), Wisconsin (-3.87%), Nevada (-3.83%) and Kansas (-3.82%). Meanwhile, rates for Puerto Rico (-1.94%), Massachusetts (-3.24%), Washington (-3.31%), New York (-3.39%), and West Virginia (-3.47%) decreased the least. When states were grouped into U.S. Census regions, no significant regional differences in pain management procedure reimbursement changes could be observed. Only the facility prices of the top 10 highest-grossing procedure and E/M CPT codes that had available data for 2014 to 2023 could be included in our analysis; trends for private insurance reimbursement could not be analyzed. Medicare reimbursement rates for interventional pain procedures have decreased from 2014 to 2023, both nationally and in each region of the U.S. Our analysis suggests that certain states and territories have experienced less favorable reimbursement trends than others. This issue is worthy of attention as larger proportions of the U.S. population become eligible for Medicare coverage; should these trends continue, interventional pain physicians may consider moving their practices to areas that are less affected.”

According to the news editors, the research concluded: “Major efforts are required to preserve the quality of care that Medicare beneficiaries receive and to remedy the problem of depreciating reimbursement.”

This research has been peer-reviewed.

For more information on this research see: National and Geographic Trends In Medicare Reimbursement for Pain Management 2014-2023. Pain Physician, 2024;27(7). Pain Physician can be contacted at: Am Soc Interventional Pain Physicians, 81 Lakeview Dr, Paducah, KY 42001, USA.

The news editors report that additional information may be obtained by contacting Miles Day, Texas Technical University, Health Sciences Center, Dept. of Anesthesiology, 3601 4TH St Stop 7415, Lubbock, TX 79430, United States. Additional authors for this research include George Wiest, Alexander Dorius and Carson Bateman.