Accountable interventional pain management: a collaboration among practitioners, patients, payers, and government.

摘要: The prevalence, costs, and disability associated with chronic pain continue to escalate. So too, the numerous modalities of treatments applied in managing these patients increase as well. In period from 2000 2011 interventional techniques increased 228%. addition, analysis utilization trends expenditures for spinal alone 2008 illustrated an Medicare fee-for-service 240% terms dollars spent United States. Office Inspector General (OIG) Department Health Human Services showed facet joint transforaminal epidural injections, a significant proportion services did not meet medical necessity criteria.The increasing is also variations among specialty groups regional states. Overall procedures have by 173%, rate 130% per 100,000 beneficiaries injections; 383%, 308% interventions; overall 410%, or 331% sacroiliac interventions. Certain high volume interventions such lumbar injections neurolysis actually staggering 806% 662%.Coverage policies across ambulatory settings multiple payers are highly variable. Apart variability development coverage policies, payments substantially vary site service. general, amongst various highest made hospital outpatient departments (HOPDs)  lowest in-office procedures, payment surgery centers (ASCs) falling somewhere middle.This manuscript describes many differences that exist between settings, includes suggestions accountable management evidence, addressing excessive use specific techniques, equalizing settings.