This study shows that a practice-based telemedicine system can produce meaningful improvement in markers of telestroke efficiency in the face of rapid growth of a telestroke network.

Objective To evaluate the role and growth of independently billing otolaryngology (ORL) advanced practice providers (APPs) within a Medicare population. Study Design Retrospective cross-sectional study. Setting Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data Files, 2012-2017. Methods This retrospective review included data and analysis of independent Medicare-billing ORL APPs. Total sums and medians were gathered for Medicare reimbursements, services performed, number of patients, and unique Current Procedural Terminology ( CPT) codes used, along with geographic and sex distributions. Results There has been near-linear growth in number of ORL APPs (13.7% to 18.4% growth per year), with a 115.4% growth from 2012 to 2017. Similarly, total Medicare-allowed reimbursement (2012: $15,568,850; 2017: $35,548,446.8), total number of services performed (2012: 313,676; 2017: 693,693.7), and total number of Medicare fee-for-service (FFS) patients (2012: 108,667; 2017: 238,506) increased. Medians of per APP number of unique CPT codes used, Medicare-allowed reimbursement, number of services performed, and number of Medicare FFS patients have remained constant. There were consistently more female APPs than male APPs (female APP proportion range: 71.3%-76.7%). Compared to ORL physicians, there was a significantly greater proportion of APPs practicing in a rural setting as opposed to urban settings (2017: APP proportion 13.6% vs ORL proportion 8.4%; P < .001). Conclusion Although their scope of practice has remained constant, independently billing ORL APPs are rapidly increasing in number, which has led to increased Medicare reimbursements, services, and patients. ORL APPs tend to be female and are used more heavily in regions with fewer ORL physicians.

Background Studies have suggested that physicians are steadily being paid less per Medicare service over time based on inflation‐adjusted dollars. The objective of this study was to determine whether this phenomenon was true for rhinologic procedures. Methods This study was a retrospective analysis of the 2000‐2021 Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule investigating fees for in‐office endoscopies (Current Procedural Terminology [CPT] codes 31231‐31238), in‐office balloon ostial dilation (CPTs 31295‐31298), in‐facility low‐relative value unit (RVU) surgeries (<10 work RVUs [wRVUs]; CPTs 31239‐31288 and 61782), and in‐facility high‐RVU surgeries (>10 wRVUs; CPTs 31290‐31294). Total number of and reimbursements for these services was obtained from yearly National Part B Summary Datafiles. Results Between 2000 and 2021, adjusted reimbursements for low‐ and high‐wRVU rhinologic surgeries decreased by 50.0% and 36.1%, respectively. The average compound annual growth rate (CAGR) decrease was 3.3% and 2.1%, respectively. Excluding a 48.3% unadjusted reimbursement increase between 2000 and 2004, endoscopies saw an adjusted reimbursement decrease of 29.4% from 2004 onward, an average CAGR of −2.1%. From 2011 onward, balloon ostial dilations saw a decrease in adjusted reimbursement of 43.8%, an average CAGR of −6.0%. Nevertheless, after inflation adjustment, National Part B data reveal that Medicare paid more, in total, for these procedures in 2019 than in 2000 due to increasing utilization. Conclusion Medicare reimbursements are complex, adjusted yearly, and undergo constant federal scrutiny due to the increasing costs of health care. These results suggest that, in terms of real dollars, rhinologic procedures have seen a large gradual decrease in Medicare reimbursement, which is important information for policymakers and surgeons alike.