Introduction: Healthcare resource utilization and pain reduction have important implications in selection of providers performing permanent spinal cord stimulation (SCS) for patients with chronic pain. The present study examines healthcare resource utilization based on the provider implant volume.
Methods: A large retrospective analysis using the Thomson Reuters MarketScan database was designed. We included all adult patients who underwent a percutaneous or paddle spinal cord stimulator (SCS) trial with or without IPG implantation from the years 2000 to 2012. Patients were included if they received an implant from a provider type (neurosurgery, orthopedics, anesthesiology, etc.) that performs SCS with frequency (>100 implants). Patients were then grouped according to individual provider case volume into three groups: high (>29), medium (10-29), and low (<10) volume providers. High vs. low volume groups were analyzed in univariate and multivariate models to evaluate factors associated with healthcare resource utilization.
Results: A total of 19,605 unique instances of trial implants were identified in the 698 providers included. Overall, 12,375 (63.1%) of those receiving trials went on to have a permanent SCS system installed within the subsequent three months. Providers classified as high volume implanters performed 31.2% of all SCS implants. Higher volume providers were associated with reduced total cost of all medication ($3,804.10 in high vs. $4,697.10 in low; p<0.0001), reduced total cost of pain medication ($1,054.30 vs. $1,510.30; p<0.0001), and reduced total cost ($109,568.00 vs. $134,128.00; p< 0.0001).
Conclusions: In this national cohort study of patients, we identified how provider volume impacts healthcare resource utilization in SCS. Our results suggest improved outcomes when the trial device implantation is performed by high volume providers. Despite limitations regarding the database nature, our study portends the need for streamlining refractory pain patients to providers who perform SCS procedures with high frequency.
Patient Care: Patient outcomes and procedure expenses are significant considerations when managing chronic pain. As displayed, considering the provider’s experience with performing SCS can lead to improved outcomes and reduced costs, which is beneficial for patient care and ensures responsible healthcare utilization.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand how procedure volume differs among SCS providers, 2) Describe the differences in outcome between low- and high-volume providers, and 3) Identify variations in healthcare resource utilization based on provider procedure volume.