Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits

Abstract

Objective To analyze the spatial variation of sociodemographic factors associated with the geographic distribution of new patient visits to otolaryngologists. Study Design Retrospective cross-sectional analysis. Setting United States. Subject and Methods Medicare new patient visits pooled from 2012 to 2016 to otolaryngology providers were obtained from the Centers for Medicare and Medicaid Services, and county-level sociodemographic data were obtained from the 2012-2016 American Community Survey. The mean number of new patient visits per otolaryngology provider by county was calculated. The spatial variation was analyzed with negative binomial and geographically weighted regression. Predictors included various neighborhood characteristics. Results There were 7,199,129 Medicare new patient visits to otolaryngology providers from 2012 to 2016. A 41.7-fold difference in new patient evaluation rates was observed across US counties (range, 11-458.8 per otolaryngology provider). On multivariable regression analysis, median age, sex, work commute time, percentage insured, and the advantage index of a county were predictors for the rate of new patient visits to otolaryngology providers. However, geographically weighted regression demonstrated that the association of a county’s disadvantage index, advantage index, percentage insured, and work commute times with new patient visits per provider varied across space. Conclusions There are wide geographic differences in the number of new Medicare patients seen by otolaryngologists, and the influence of county sociodemographic factors varied regionally. Further research to analyze the variations in practice patterns of otolaryngologists is warranted to predict future public health needs.

Ambulatory visits for common rhinologic complaints in the United States: A patient‐centered perspective

“…The percentage of total visits in metropolitan versus nonmetropolitan areas, respectively, was reported by 55.8% and 90.2% in primary care, 19.3% and 5.2% in otolaryngology, and 18.4% and 1.6% in allergy/pulmonology. This reflects a relative scarcity of subspecialists in nonmetropolitan areas and contributes to the differences seen in patient presentation for those settings 3,5 …”

“…This reflects a relative scarcity of subspecialists in nonmetropolitan areas and contributes to the differences seen in patient presentation for those settings. 3,5 The only R-RFVs that were seen most frequently by otolaryngologists were epistaxis and inflammation/swelling of the nose. 7,8 This suggests appropriate selection of specialty care, as studies have shown that otolaryngologists perform the most epistaxis-related interventions in the Medicare population nationally.…”

“…Although many prior studies have been conducted to identify practice differences between primary care and otolaryngology, 2,3,5,7 no published studies have, to our knowledge, identified patient prevalence according to specialty based on rhinologic concerns. This study is unique in that it presents symptom-and patient-driven use of resources rather than diagnoses assigned by medical professionals.…”

“…It illuminates the variability of patient experience in a way that has not yet been described. 1,[3][4][5][6]…”