Hyaluronic acid injections increased for all providers from 2012 to 2018
Click Here to Manage Email Alerts
Use of hyaluronic acid injections significantly increased among Medicare beneficiaries for all providers from 2012 to 2018, with advanced practice providers largely contributing to the increase, according to published results.
Atul F. Kamath, MD, and colleagues used the 2012 to 2018 Medicare Fee-for-Service Provider Utilization and Payment Public Use Files to collect payment and utilization data for all Healthcare Common Procedure Coding System codes corresponding to hyaluronic acid (HA) injection. They calculated the number of services involving HA as well as the total cost of HA administration in 2020 U.S. dollars, and evaluated trends in utilization for providers nationally and when segregated by specialty using Mann-Kendall trend tests.
Results showed a significant increase in total utilization of HA from 2012 to 2018. Despite no significant changes in total utilization rates found among orthopedic surgeons, researchers noted a significant increase in the average number of services per orthopedic surgeon. Utilization of HA injections and associated costs significantly increased among physician assistants and nurse practitioners, according to results. Researchers also found a significant increase in total costs associated with HA services from $290.10 million in 2012 to $325.02 million in 2018.
“Despite the American Academy of Orthopaedic Surgeons recommendations against the use of HA injections, our analysis demonstrated that they continue to be widely implemented among Medicare beneficiaries,” Kamath told Healio. “Given the large financial burden associated with this low-value care, our findings encourage stronger utilization policies, as well as improved education, to limit inappropriate HA use among orthopedic surgeons and advanced practice providers.”
Perspective
Back to Top
HA is commonly used to treat painful osteoarthritis of the knee joint. The AAOS clinical practice guidelines (CPG) for the management of knee arthritis in 2013 recommended against its use. However, other CPGs support the use of HA to treat knee OA. In this study, the authors assessed a large Medicare database to determine the overall utilization and health care costs associated with HA injections among Medicare beneficiaries between 2012 to 2018. A significant increase in HA utilization was noted during this time period, despite the AAOS guidelines. Most of this increase was attributed to HA injections provided by advanced practice providers. Some recent studies have demonstrated comparable pain relief between HA and NSAID injections. Furthermore, it has been documented that the use of HA can delay total knee arthroplasty. However, there is no consensus regarding the specific indications for HA injections to treat knee OA particularly related to degenerative changes on plain radiographs or MRI. In addition, the efficacy of single vs. multiple HA injections has not been determined. An appropriately powered multicenter randomized clinical trial is necessary to answer these questions.
Collapse
Read more about
Click Here to Manage Email Alerts