Trends in utilization of lumbar facet injection and radiofrequency ablation through Veterans Health Administration: 2007-2020.

Abstract

Previous studies have described utilization trends for lumbar facet pain procedures (LFP) over the past 2 decades in Medicare and commercially-insured populations. No studies have examined LFP utilization in the United States Veterans Health Administration (VHA) healthcare system. To describe trends in utilization of LFP provided through VHA benefits from 2007-2020, including differences in utilization between VHA care and VHA-purchased care. Retrospective cohort study. All Veterans in the VHA healthcare system. Annual rates of utilization of lumbar facet injections (LFI) and lumbar medial branch radiofrequency ablation (LMBRFA) procedures. We used the VHA Corporate Data Warehouse to identify procedures to treat lumbar zygapophyseal joint pain performed in or purchased by VHA from 2007 to 2020. Descriptive analyses were performed to describe differences in utilization of LFI and LMBRFA procedures over time. During the 14-year study period, the number of LFP performed in or purchased by VHA per 100,000 enrollees increased by 298% for LFI and 767% for LMBRFA. The enrollee-adjusted growth in utilization for purchased care (1586% [average annual growth of 122%] for LFI and 3443% [average annual growth of 265%] for LMBRFA) outpaced observed growth in VHA care (70% [average annual growth of 5%] for LFI and 244% [average annual growth of 19%] for LMBRFA). Purchased care billed for more spinal levels during LFI than VHA care (5.32 vs 3.71) and performed more procedures than VHA facilities at the end of the study period (2020). There was substantial growth in the use of LFP among VHA enrollees from 2007-2020. Between 2007 and 2016, growth was greater than that in the Medicare and commercially-insured populations over the same time period. Growth was considerably greater among enrollees receiving LFP purchased by VHA from non-VHA facilities compared to VHA facilities. The steepest increase in utilization occurred after 2014, coinciding with policy changes to increase access to care provided by non-VHA providers.