Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 2:20:100565.
doi: 10.1016/j.xnsj.2024.100565. eCollection 2024 Dec.

Health care utilization among Medicare beneficiaries with newly diagnosed back pain

Maria Isabel Barros Guinle  1 , Thomas Johnstone  1 , Gabriela D Ruiz Colón  1 , Yingjie Weng  2 , Ella A Nettnin  1 , John K Ratliff  1
Affiliations

Health care utilization among Medicare beneficiaries with newly diagnosed back pain

Maria Isabel Barros Guinle et al. N Am Spine Soc J. .

Abstract

Background: Low back pain (LBP) is the most common medical cause of disability among adults 65 or older. No previous study has characterized health care costs and treatment patterns of LBP among Medicare beneficiaries.

Methods: This retrospective cohort study quantifies health care utilization costs among Medicare beneficiaries with newly diagnosed LBP, compares costs between patients managed operatively and nonoperatively, identifies costs associated with treatment guideline nonadherence, and characterizes opioid prescribing patterns. Patients were queried via ICD codes from a 20% random sample of Medicare claims records. Patients with concomitant or previous "red flag" diagnoses, neurological deficits, or diagnoses that could cause nondegenerative LBP were excluded. Total costs of care in the year of diagnosis were calculated and stratified by operative versus nonoperative management. To assess for guideline adherence, utilization and costs of different services were tabulated. Opioid prescription patterns were characterized by quantity, cost, duration, and medication type.

Results: About 1,269,896 patients were identified; 23,919 (1.8%) underwent surgery. These accounted for 7% of the cohort's total cost ($514 million total, $21,496 per person). Patients treated nonoperatively accounted for over $7 billion in costs ($5,880 per person; p<.001). Within the nonoperative cohort, 626,896 (50.3%) patients were nonadherent to current guidelines for conservative management of LBP. Guideline nonadherence increased total annual costs by $4,012 per person ($7,873 for nonadherent vs. $3,861 for adherent patients, p<.001). About 460,867 opioid prescriptions were filled for 303,796 unique patients (23.9%) within 30 days of LBP diagnosis. Within the nonsurgical cohort, patients nonadherent to imaging guidelines were more likely to have an opioid prescription within this window than adherent patients (26.5% vs. 21.2%; p<.001).

Conclusions: Nonoperative management of LBP is associated with significantly lower costs per patient. Early imaging and opioid prescription are significant drivers of excess cost. Adherence to proposed treatment guidelines can save over $2.8 billion in total health care costs.

Keywords: Guideline adherence; Health care utilization; Imaging; Low back pain; Medicare; Nonoperative management.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors declare financial or professional relationships on ICMJE-NASSJ disclosure forms.

Figures

Fig 1
Fig. 1
Cohort construction flowchart.
Fig 2
Fig. 2
Number of patients and percentage of total 12-month costs based on different management patterns for patients in the nonsurgical cohort.
Fig 3
Fig. 3
Number of patients and sum of total 12-month costs based on different management patterns for patients in the surgical cohort.
See this image and copyright information in PMC

References

    1. Vespa J, Medina L, Armstrong D. U.S. Census Bureau; Washington, DC: 2020. Demographic turning points for the united states: population projections for 2020 to 2060 population estimates and projections current population reports.https://www.census.gov/content/dam/Census/library/publications/2020/demo... Accessed March 15, 2024.
    1. Get started with Medicare | Medicare. www.medicare.gov. https://www.medicare.gov/basics/get-started-with-medicare#:∼:text=Medica... Accessed March 15, 2024.
    1. Wong AYL, Karppinen J, Samartzis D. Low back pain in older adults: risk factors, management options and future directions. Scoliosis Spinal Disord. 2017;12:14. - PMC - PubMed
    1. Bressler HB, Keyes WJ, Rochon PA, Badley E. The prevalence of low back pain in the elderly. A systematic review of the literature. Spine (Phila Pa 1976) 1999;24(17):1813–1819. - PubMed
    1. Podichetty VK, Mazanec DJ, Biscup RS. Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J. 2003;79(937):627–633. - PMC - PubMed

LinkOut - more resources