Medicare Utilization and Reimbursement Variation Between Rural and Urban Otolaryngologists

Abstract

Objective To compare billing practices, reimbursement rates, and patient populations of otolaryngology (ORL) physicians practicing in rural and urban settings. Study Design Retrospective cross-sectional study. Setting Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data. Methods Medicare-allowed payments, number of services, and number of patients were gathered along with patient population comorbidity statistics, including average hierarchical condition category risk scores. Results In 2019, 92% of the overall total 8959 ORL physicians practiced in an urban setting. These 8243 urban ORL physicians, on average, billed for 51 (interquartile range [IQR], 31-67) unique Healthcare Common Procedure Coding System (HCPCS) codes, cared for 393 (IQR, 172-535) Medicare patients, performed 1761 (IQR, 502-2070) services, and collected $139,957 (IQR, $55,527-$178,479) per provider. In contrast, the 704 rural ORL physicians, on average, billed for a greater number of unique HCPCS codes (59; IQR, 37-77; P < .001), treated more Medicare patients (445; IQR, 242-614; P < .001), and performed more services (2330; IQR, 694-2748; P < .001) but collected about the same per provider ($141,035; IQR, $56,555-$172,864; P = .426). Older age was associated with rural practice ( P = .027). Among both urban and rural ORL physicians, the variety and complexity of procedures and patient comorbidity profiles were comparable. Conclusion Most ORL physicians practice in large urban settings, a finding potentially related to financial sustainability and career opportunity. With an already small workforce, the aging rural ORL physician population is an identifiable weak point in the otolaryngology specialty that must be addressed with geo-specific recruitment campaigns, rural work incentivization, and the development of career advancement opportunities in rural areas.

Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volumes Among Fellowship-Trained Glaucoma Subspecialists

“…The RUCA system allows for comparisons between rural and urban US areas at the subcounty level. Precise provider practice locations were extracted from the CMS PUF and, like prior studies, categorized as either urban or rural 13 . Among fellowship-trained glaucoma surgeons, cumulative volumes per procedural category per year were determined after stratification by RUCA-designated urban or rural areas of surgical practice.…”

“…Precise provider practice locations were extracted from the CMS PUF and, like prior studies, categorized as either urban or rural. 13 Among fellowship-trained glaucoma surgeons, cumulative volumes per procedural category per year were determined after stratification by RUCA-designated urban or rural areas of surgical practice. The categorization of RUCA codes and the number of glaucoma surgeons enlisted in each category are provided in Table 1.…”