Radiologists have dominated the burgeoning market for an image-guided approach to relieve bone pain, but other specialists present a growing threat, experts warned Monday.
Claims for such ablation increased dramatically between 2015-2018, with a more than 45% average year-over-year growth in the Medicare program. Radiologists saw their share fall from almost 81% down to 73% while neurosurgeons recorded the largest gain, leaping from 5% to more than 11%, researchers detailed in Clinical Imaging.
Interventional radiologist and study co-author Mona Ranade, MD, believes the trend warrants attention as popularity for minimally invasive procedures continues to swell.
“While the field of radiology is still a predominant figure in performing osseous ablation, the relative growth by other specialties in the procedure traditionally performed by radiologists suggests a threat to future procedure volume growth,” Ranade, with UCLA Health, and co-authors with Mount Sinai Hospital in New York, where she served as a fellow, wrote Dec. 13. “Radiologists may benefit from taking part in the multidisciplinary team taking care of patients with bone metastases and increasing clinical involvement, which will enhance its presence as the specialty with greater expertise in performing the procedure of choice,” they added.
Bone pain due to cancer that has metastasized is common and often can become chronic. Upward of 80% of patients with primary breast, prostate and lung cancers experience such osseous metastases as the disease spreads to the bones, and 79% experience corresponding discomfort. There are multiple image-guided approaches to relieving such pain, Ranade et al. noted. But radiofrequency ablation using electricity to heat up the nerve tissue to stop pain signals, along with cryoablation using extremely cold liquid, are the only two with billable codes.
For their study, investigators tracked annual volume of billed services for these two approaches using data from Medicare claims submitted by physicians and other providers. Radiofrequency ablation showed substantial unadjusted growth, climbing 252% during the four-year study period while cryoablation climbed 144%. Radiology led the way with the most ablation claims from 2015-2018 at 76%, followed by neurosurgery (9%), orthopedics (7%), and pain management (6%). The latter also saw its market share climb alongside neurosurgeons’, leaping from 3% to 6%.
Outpatient hospitals were the dominant site of service (63%) followed by the inpatient locales (30%). The two sites also saw similar growth rates during the study period. Outpatient procedures by radiologists increased slightly, from 53% up to 65%, while inpatient delivery by pain management specialists leapt from 13% to almost 48%.
Ranade and co-authors said their data should not be viewed as stagnation or a reduction in cases handled by radiologists. Rather the focus must turn toward pain management specialists and neurosurgeons, who saw their share grow fourfold and sixfold, respectively.
“One possible explanation is that there are few barriers to incorporating osseous ablation into a practice as it requires relatively little equipment and can often be done with just a C-arm, hence allowing more neurosurgeons and pain specialists to quickly become proficient at the procedure,” the authors speculated. “Growing recognition of pain as a specific disease process, and not a mere symptom of more complicated pathology, and the accompanying growth in the field of pain medicine, may also have contributed to the trend. Lastly, referral patterns from patients’ primary care providers or oncologists may be another contributing factor.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.