Abstract
Objectives:
Rotator cuff disease is one of the most common reasons for people to seek upper extremity specialty care. Rotator cuff tendinopathy is typically a part of the normal aging process and is often well adapted. Healthcare utilization for the condition varies widely and can range from formal physical therapy to surgery. Evidence of the effectiveness of some interventions for rotator cuff tendinopathy is lacking and for others, such as steroid injection or subacromial decompression, suggests no benefit. There is an opportunity to streamline care for this common condition and, in doing so, conserve finite healthcare resources. The purpose of this study was to characterize the current healthcare utilization for rotator cuff tendinopathy using a large claims database in an effort to identify opportunities to streamline care and develop value-based treatment algorithms.
Methods:
Using de-identified records in a large claims data base that includes over 350 private-sector payers, we identified patients with a new visit claim between April and June 2016 in one state with an ICD-10 diagnosis code for rotator cuff tendinopathy. The most common atraumatic diagnoses and the frequency of interventions, such as surgery, physical or occupational therapy, advanced imaging, and injections were tracked. We recorded all return visits (including post-operative visits), tests, treatments, and costs for 3 months prior and 6 months after diagnosis. We then calculated the potential cost savings using an alternative treatment strategy for rotator cuff tendinopathy based on value-based care principals.
Results:
The percentage of enrollees undergoing specific interventions was MRI 19%; physical therapy visit 29%; injections 52%; return visits 44%; and surgery 17%. Alternative treatment strategies, such as a reliance on home exercises rather than formal physical therapy, avoidance of injections and limiting MRIs to patients considering surgery accounted for a potential mean payment that was 8% of the actual mean payments of claims paid out in the database.
Conclusions:
Conclusion: Our analysis identified notable variation in care of people with rotator cuff tendinopathy. Alternative treatment strategies identified an opportunity for improving value given growing evidence that limiting some of the more commonly used interventions is unlikely to diminish health and might even improve it by increasing self-efficacy.