Acupuncture for Medicare Beneficiaries with Chronic Low Back Pain: Access, Utilization, and Outcomes

SUMMARY In 2020, following a thorough assessment of the scientific evidence on acupuncture, the Centers for Medicare & Medicaid Services (CMS) issued the decision to initiate coverage of acupuncture for management of chronic low back pain (cLBP) in Medicare beneficiaries. cLBP is a highly prevalent and difficult to manage

condition, particularly in the highly vulnerable Medicare beneficiary population, and many patients with cLBP continue to receive prescriptions for analgesic medication despite evidence-based clinical guidelines that prioritize use of non-pharmacologic therapies, including acupuncture. Therefore, the CMS decision to cover

acupuncture promises to improve the quality of care for Medicare beneficiaries with cLBP by providing an alternative to high-risk pharmacological interventions. The principal objective of this project is to assess the impact of the new CMS decision upon patient outcomes. Thus, the first aim of the project will be to compare

safety, efficiency of care, and costs of care for Medicare beneficiaries receiving acupuncture as compared to pharmacotherapy for management of cLBP. Because the CMS decision came with restrictions on coverage that could impact equitable access to care, important project objectives will also include measuring the

availability of acupuncture providers under Medicare, describing patterns and trends in utilization of acupuncture by Medicare beneficiaries, and determining facilitators and barriers to the use of acupuncture for both providers and patients. The approach to the first aim will be to analyze nationally representative Medicare

claims data, using cohort, crossover cohort and interrupted time series designs. Availability and utilization will be evaluated through cross-sectional analysis of Medicare claims data combined with collected data on the supply of acupuncture providers. The approach to the assessment of facilitators and barriers for acupuncture

will be to conduct focus groups and analyze the results using an immersion-crystallization approach. This study is expected to find that use of acupuncture by Medicare beneficiaries is associated with an equivalent or superior impact on the safety, efficiency of care, and costs of care for cLBP as compared to pharmacotherapy,

and to demonstrate that the decision to allow coverage of acupuncture has had a positive impact on healthcare outcomes for Medicare patients with cLBP. The research is also expected to reveal provider and patient attitudes and beliefs about use of acupuncture under Medicare, and may reveal unwarranted variation in the

availability and utilization of acupuncture under Medicare. The project is expected to make significant contributions to improvements in the care of patients with cLBP by strengthening the evidence in favor of the utilization of acupuncture by Medicare beneficiaries and hastening its systematic adoption in a way that

ensures equitable patient access to high value spine care.