The association of payer type on genicular radiofrequency neurotomy treatment outcomes: Results of a cross-sectional study

Samantha Braun; Jason Mascoe; Marc Caragea; Tyler Woodworth; Tim Curtis; Michael Blatt; Cole Cheney; Todd Brown; Daniel Carson; Keith Kuo; Dustin Randall; Emily Y Huang; Andrea Carefoot; Masaru Teramoto; Amanda Cooper; Megan Mills; Taylor Burnham; Aaron Conger; Zachary L McCormick

doi:10.1016/j.inpm.2024.100407

The association of payer type on genicular radiofrequency neurotomy treatment outcomes: Results of a cross-sectional study

Interv Pain Med. 2024 Apr 5;3(2):100407. doi: 10.1016/j.inpm.2024.100407. eCollection 2024 Jun.

Authors

Samantha Braun¹, Jason Mascoe², Marc Caragea², Tyler Woodworth², Tim Curtis², Michael Blatt³, Cole Cheney⁴, Todd Brown³, Daniel Carson², Keith Kuo³, Dustin Randall³, Emily Y Huang⁵, Andrea Carefoot², Masaru Teramoto², Amanda Cooper², Megan Mills⁶, Taylor Burnham², Aaron Conger², Zachary L McCormick²

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Texas San Antonio, San Antonio, TX, USA.
² Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA.
³ School of Medicine, University of Utah, Salt Lake City, UT, USA.
⁴ Mayo Clinic Health System, Mankato, MN, USA.
⁵ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Department of Radiology, University of Utah, Salt Lake City, UT, USA.

Abstract

Background: Genicular radiofrequency neurotomy (GRFN) is an effective treatment for a subset of individuals with chronic knee pain. Previous studies demonstrate that Medicare and Medicaid beneficiaries report worse outcomes following various interventional procedures compared with commercially insured patients.

Objective: Evaluate the association of payer type on GRFN treatment outcomes.

Methods: Consecutive patients who underwent GRFN at a tertiary academic center were contacted for participation. Demographic, clinical, and procedural characteristics were collected from electronic medical records. Outcome data were collected by standardized telephone survey at 6-12 months, 12-24 months and ≥24 months. Treatment success was defined as ≥50% numerical pain rating scale (NPRS) score reduction from baseline. Data were analyzed using descriptive statistics for demographic, clinical, and procedural characteristics. Logistic and Poisson regression analyses were performed to examine the association of variables of interest and pain reduction.

Results: One hundred thirty-four patients treated with GRFN (mean 65.6 ± 12.7 years of age, 59.7% female) with a mean follow-up time of 23.3 ± 11.3 months were included. Payer type composition was 48.5% commercial (n = 65), 45.5% Medicare (n = 61), 3.7% Medicaid (n = 5), 1.5% government (n = 2), and 0.8% self-pay (n = 1). Overall, 47.8% of patients (n = 64) reported ≥50% NPRS score reduction after GRFN. After adjusting for age, follow-up duration, Kellgren-Lawrence osteoarthritis grade, baseline opioid use, antidepressant/antianxiety medication use, history of knee replacement, and number of RFN lesions placed, the logistic regression model showed no statically significant association between payer type and treatment outcome (OR = 2.11; 95% CI = 0.87, 5.11; p = 0.098).

Discussion/conclusion: In this study, after adjusting for demographic, clinical, and procedural characteristics, we found no association between payer type and treatment success following GRFN. This observation contrasts findings from other interventional studies reporting an association between payer category and treatment success.

Keywords: Genicular nerve; Knee pain; Osteoarthritis; Payer type; Radiofrequency ablation.